Thus, do we care of energy source?
Therefore, assuming the extension of area of lesion is comparable
between PFA and RF, could we foresee the same clinical behavior?
Electroporation is characterized by a nonthermal energy source in which
electrical fields are used to induce cardiomyocyte-specific cell death,
thus avoiding adjacent anatomical structures (7). Initial clinical
observations in controlled trials reported data on high degree of safety
and acute efficacy and follow-up data of PFA-based PVI not significantly
different from more conventional ablative therapy (8,9). On the other
hand, the RFB is a compliant balloon catheter compatible with a 3D
electroanatomical mapping system (CARTO 3, Biosense Webster, CA, USA)
and provides an established energy source. One of the main advantages of
this technology is the selective titration of RF energy delivery from
each surface electrode to reduce collateral damage and to apply energy
in a segmental area if needed (10). Multicenter trials (RADIANCE (10,11)
and SHINE (12)) demonstrated the feasibility, safety, and 12-month
outcome of this technology.
The wealth of clinical data collected from trials seems to indicate a
comparable outcome between the two modalities of ablation but higher
safety profile of electroporation over different energy sources (
especially RF current). How much crucial is the extension of area of
ablation towards the posterior wall in affecting the durability of
lesions produced is still unknown.
At the end of the day, we all dream to devise the most successful
ablative approach as to ensure a stable regular sinus rhythm to our AF
patients, but undoubtedly there still a need to gather additional
insights into these two novel strategies of treatment before declaring
the final winner.