Acute Procedural Results of Pulsed Field Cryoablation for Persistent
Atrial Fibrillation: Multicenter First-in-Human PARALELL Trial
Abstract
Introduction: Pulsed Field Cryoablation (PFCA) is a dual-energy
cardiac ablation modality consisting of short-duration ultra-low
temperature cryoablation (ULTC) followed immediately by pulsed field
ablation (PFA) delivered from the same catheter. It is hypothesized that
PFCA may improve contact stability during PFA, while maintaining lesion
depth and effectiveness of ULTC. Methods: PARALELL is a
first-in-human multicenter study evaluating safety and effectiveness of
a novel PFCA catheter and system in patients with persistent atrial
fibrillation (PsAF) using the combination of pulmonary vein (PVI) and
posterior wall (PWI) isolation. Results: 66 patients were
ablated at six sites. Groin hematoma in one patient was the only serious
procedure- or device-related adverse event recorded in the study. Per
protocol, acute effectiveness was evaluated in 46 patients, including 31
patients with post-hoc analysis of cryogenic energy per lesion. After an
average of 21.1 ± 9.3 lesions per patient the rates of PVI and PWI were
95.7% (176/184) and 97.7% (42/43), respectively. The average cryogenic
energy per patient was highly predictive of acute isolation success with
ROC AUC = 0.944 and 100% rates of both PVI and PWI in 24 patients in
the optimal energy cohort. Grade I microbubbles and faint muscle
contractions were detected in 1.1% and 0.5% of ablations,
respectively. Conclusion: This initial multi-center experience
suggests that PFCA can be efficiently performed for PVI and PWI using a
single versatile catheter system, with high acute success and good early
safety profile. The evaluation of the chronic 12-month effectiveness of
PFCA is ongoing.