Pulsed field ablation for atrial fibrillation – Lessons from magnetic resonance imaging

• Published in: Pacing and clinical electrophysiology Vol. 46; no. 12; pp. 1586 - 1594
• Main Authors: Fink, Thomas, Sciacca, Vanessa, Neven, Kars, Didenko, Maxim, Sommer, Philipp, Sohns, Christian
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2023
• Subjects: atrial fibrillation; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - surgery; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - surgery; Cardiomyopathy; Catheter Ablation - methods; Contrast Media; Electroporation; Fibrillation; Fibrosis; Gadolinium; Heart Atria - diagnostic imaging; Heart Atria - pathology; Heart Atria - surgery; Humans; lesion formation; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; pulsed field ablation; atrial fibrillation; lesion formation; magnetic resonance imaging; pulsed field ablation
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14864

Pulsed field ablation (PFA) is a promising technology for the treatment of atrial fibrillation (AF). Due to its unique tissue selectivity, PFA potentially bears superior characteristics as compared to established thermal energy sources in AF ablation procedures. Cardiovascular magnetic resonance imaging (CMR) using late gadolinium enhancement (LGE) is an established tool in the analysis of myocardial fibrosis representing atrial cardiomyopathy as well as ablation‐induced atrial scar formation following catheter ablation with thermal energy. Mechanisms of atrial lesion formation differ between thermal ablation and electroporation and its impact on results of CMR imaging are not fully understood until now. In this review article, the potential of CMR imaging for PFA lesion assessment and available data are discussed. Further, additional needs to adopt imaging approaches to the cellular mechanisms of electroporation are considered.