Pulsed Electric Field, Cryoballoon, and Radiofrequency for Paroxysmal Atrial Fibrillation Ablation: A Propensity Score-Matched Comparison.

BACKGROUND AND AIMS

Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We describe a multicenter experience on pulmonary vein isolation (PVI) via the pentaspline FarapulseTM PFA system versus thermal-based technologies in a propensity score-matched population of paroxysmal atrial fibrillation (PAF) patients.

METHODS

Propensity score matching was adopted to compare PVI-only ablation outcomes via the FarawaveTM system (Group PFA), cryoballoon (Group CRYO), or focal radiofrequency (Group RF) (PFA:CRYO:RF Ratio=1:2:2).

RESULTS

Among 1572 (mean age: 62.4±11.3 years; 42.5% females) PAF patients undergoing first-time PVI with either PFA (n=174), CRYO (n=655), or RF (n=743), propensity score matching yielded 174 PFA, 348 CRYO, and 348 RF patients.First-pass isolation was achieved in 98.8% of pulmonary veins (PVs) with PFA, 81.5% with CRYO, and 73.1% with RF (p<0.001).Procedural and dwell times were significantly shorter with PFA, whereas the availability of a 3D mapping system led to a significant reduction in x-ray exposure with RF.Overall complication rates were 3.4% (n=6) with PFA, 8.6% (n=30) with CRYO, and 5.5% (n=19) with RF (p=0.052). The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 79.3% with PFA, 74.7% with CRYO, and 72.4% with RF (log-rank p-value: 0.24).Among 145 repeat ablation procedures, PV reconnection rate was 19.1% after PFA, 27.5% after CRYO, and 34.8% after RF (p=0.01).

CONCLUSION

PFA contributed to significantly shorter procedural times. Follow-up data showed a similar arrhythmia freedom, although a higher rate of PV reconnection was documented in post-CRYO and post-RF redo procedures.

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.