Abstract
1. Using the Farapulse pulse configuration and ablation procedure
results in a significant esophageal temperature increase that is
underestimated using the Circa probe and it is likely significantly
higher temperature can be recorded at close proximity to the ablation
electrodes. 2. A near-field tissue ablation is a mix of irreversible
electroporation and thermal injury. 3. The bipolar energy delivery using
the Farawave-catheter limits the field and thermal ablation to close
proximity to the bipolar ablation electrodes limiting the impact on
extracardiac tissues. 4. In the two published papers accompanying this
editorial, the Farapulse PFA technology is shown to have no short or
long-term adverse effect on the esophagus. However, reported phrenic
nerve conduction stunning may occur (7,8). It is also noted that while
Meininghaus et al. reported significant esophageal acute injuries using
RF and Cryo no long-term data is provided that these findings resulted
in long-term disabilities. 5. PFA is hampered by the inability to
adequately assess irreversible lesion formation in real-time. 6. The
advantage provided by using PFA ablation technology is added safety and
faster procedure time. These conclusions need further affirmation when
the technology is widely used.