124 A comparative analysis of procedural outcomes between pulsed field ablation and very high-powered short duration radiofrequency ablation

Introduction Pulmonary vein isolation (PVI) is an established therapeutic strategy for atrial fibrillation (AF). Recent advancements in AF ablation have led to the development of the novel pulsed field ablation (PFA) and very High-Powered Short Duration (VHPSD) radiofrequency ablation. PFA utilizes electrical pulses to induce non-thermal irreversible electroporation to cause cell death, while VHPSD utilizes radiofrequency energy and delivers 90W for up to 4 seconds with constant irrigation. The aim of this study was to evaluate and compare procedural outcomes of both techniques. Methods A single center, retrospective observational study was conducted with patients who underwent either PFA (FARAPULSE) or VHPSD (QMODE+) radiofrequency ablation. FARAPULSE PFA system was used including three main components: steerable sheath for navigation, over the wire catheter with different distal shapes (basket & flower), and a generator for an easy three-button click to prepare, confirm, and deliver treatment. Both groups were compared regarding population demographics (table 1) and procedural outcomes (table 2) Results A total of 100 patients were included in the study with 50 patients present in each treatment arm. All patients' demographics were homogenous with no significant difference except for classification of AF (p=0.003) and pre-procedural LVEF<45% (P<0.0001) (table 1). In the PFA cohort, 26 patients (52%) and in the VHPSD cohort, 7 patients (14%) underwent general anesthesia (P<0.0001), remaining procedures in the PFA arm were done under deep sedation with IV Propofol, while remaining procedures in the VHPSD arm were done under sedation with Midazolam. PVI was successfully attained in all patients barring one patient in the VHPSD, who sustained an intraprocedural complication. VHPSD demonstrated significantly lower fluoroscopy time (median 10.6 (5.75–16.2) vs 23.3 (19–31.3) min, P<0.0001) while procedural time was significantly greater (141.0 (111.5–165.5) vs. 76.5 (59–100) min; p<0.0001). PFA demonstrated a significantly lower length of stay in comparison to VHPSD (median 0 vs 1, P<00001). There were no events of procedural mortality although one patient in each arm sustained a pericardial effusion that resulted in cardiac tamponade that was successfully treated with pericardiocentesis. Additionally, the same patient who developed pericardial effusion in the PFA group developed AF with slow ventricular response that required inpatient permanent pacemaker insertion. Conclusion In this study, PFA demonstrated a comparable procedural and safety profile to VHPSD. PFA was associated with a statistically significant reduction in procedural duration but an increase in fluoroscopy time. Overall, both procedures demonstrated feasibility with promising preliminary findings although further trials with robust methodologies and longitudinal follow-up will be pertinent to assess and compare the long-term outcomes of both treatment interventions. Conflict of Interest none