Pulsed-field ablation in early-onset atrial fibrillation had shorter procedure times (59 min) than radiofrequency ablation (94 min) with similar 1-year recurrence-free survival (69% vs 73%).
Does pulsed-field ablation improve procedural efficiency, safety, and recurrence-free survival compared to cryoballoon and radiofrequency ablation in patients ≤50 years with early-onset atrial fibrillation undergoing their first pulmonary vein isolation?
In young patients (≤50 years) with early-onset atrial fibrillation, pulsed-field ablation offers comparable 1-year effectiveness to thermal ablation modalities but with significantly shorter procedural times and an excellent safety profile.
Absolute Event Rate: 0% vs 0%
Background: Pulsed-field ablation (PFA) has emerged as a promising energy source for pulmonary vein isolation (PVI) due to its tissue selectivity and procedural efficiency.However, its role in younger patients with atrial fibrillation (AF) remains underexplored.Objective: This study compared procedural characteristics, safety, and effectiveness of PFA, cryoballoon ablation (Cryo), and radiofrequency ablation (RFA) in patients aged 50 years with early-onset AF.Methods: Consecutive patients 50 years undergoing a first PVI with PFA, Cryo, or RFA at two tertiary centers were enrolled and followed for one year.Results: Among 368 patients (median age 46 years, 17% female, 63% with paroxysmal AF), 119 (32%) underwent PFA, 95 (26%) Cryo, and 154 (42%) RFA.Median procedure durations were shorter for PFA (59 min) and Cryo (63 min) vs. RFA (94 min; p <0.001).Left atrial dwell times were also shorter with PFA (36 min) and Cryo (44 min) vs. RFA (76 min; p <0.001).Successful acute PVI was achieved in all patients.Overall, there were 3 major complications (0.8%): 1 phrenic nerve palsy (1.1%) in the Cryo group and 2 cases of tamponade (1.3%) in the RFA group.1-year Kaplan-Meier recurrence-free survival was 69% in PFA, 61% in Cryo, and 73% in RFA (p Log-rank = 0.064). Conclusion:In this multicenter study of young patients undergoing first-time PVI, PFA demonstrated favorable procedural efficiency, safety, and effectiveness supporting its potential as an effective modality in patients with early-onset AF.These findings warrant further investigation in larger data sets.
Liskij et al. (Sun,) reported a other. Pulsed-field ablation in early-onset atrial fibrillation had shorter procedure times (59 min) than radiofrequency ablation (94 min) with similar 1-year recurrence-free survival (69% vs 73%).