Key result
Fluoroless PFA eliminates radiation but increases procedure time by ~13 minutes vs conventional PFA.
Why the study?
PFA has traditionally been conducted under fluoroscopic guidance, but a new software update using EAM enables a radiation-free approach whose procedural data needed comparison with conventional fluoroscopy-guided PFA.
Does radiation-free pulsed field ablation reduce radiation exposure and alter procedural times compared to conventional fluoroscopy-guided ablation in patients with atrial fibrillation?
Does radiation-free pulsed field ablation reduce radiation exposure and alter procedural times compared to conventional fluoroscopy-guided ablation in patients with atrial fibrillation?
Radiation-free pulsed field ablation using electroanatomical mapping is feasible and eliminates radiation exposure, though it requires longer procedural times than conventional fluoroscopy-guided ablation.
Radiation-free PFA eliminates exposure in AF ablation; leaves open whether added procedural time justifies adoption pending randomized trials.
Background Pulsed field ablation (PFA) is a non-thermal, single-shot pulmonary vein isolation (PVI) technique that provides a safe and effective treatment option for catheter ablation of atrial fibrillation (AF). PVI performed with the most widely used PFA system traditionally been conducted under fluoroscopic guidance. However, a recently introduced software update allows for the use of the electroanatomical mapping (EAM) system to enable a radiation-free (ZF) PFA approach with this system. Purpose The study aimed to compare procedural data between conventional fluoroscopy- guided (non-zero fluoroscopy, NZF) and ZF PFA procedures. Methods This observational study included 28 consecutive patients who underwent ZF PFA-PVI for AF. As a control group, we analyzed the procedural data of the last 28 consecutive patients who underwent NZF PFA-PVI. The two groups were compared regarding procedural time, radiation exposure, ablation parameters, and complication rates. Results In the ZF group, fluoroscopy was completely avoided in all cases, leading to significantly lower fluoroscopy time [0 (0–0) sec vs. 413.5 (327.5–553) sec; p<0.05] and radiation dose [0 (0–0) mGy vs. 15.2 (12.1–19.4) mGy; p<0.05] compared to the NZF group. However, procedural time [42.5 (38–52) min vs. 55.5 (44.5–66) min; p<0.05], time from puncture to first ablation [21 (11–25) min vs. 26 (22.5–30) min; p<0.05], number of applications [36.5 (31–40) vs. 41 (37.5–45); p<0.05], and left atrial dwell time (22.6 ± 11.0 min vs. 36.3 ± 10.8 min; p<0.05) were all significantly shorter in the NZF group compared to the ZF group. No significant difference was observed in the time between the first and last ablation applications [NZF: 24.5 (18.5–30) min vs. ZF: 23 (19–31) min]. One vascular complication occurred in the NZF group. Conclusion Radiation-free PFA is a feasible and safe procedure; however, it requires a longer procedural time compared to conventional fluoroscopy-guided PFA.
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Torma et al. (2025) studied this question. Radiation-free fluoroless PFA completely eliminated fluoroscopy use and radiation exposure but increased procedural time by ~13 minutes compared to conventional fluoroscopy-guided PFA.
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