Pulsed field ablation yielded lower arrhythmia recurrence than radiofrequency ablation in paroxysmal AF (2.1% vs 15.8%; P=0.011), with similar outcomes in persistent AF.
Cohort (n=192)
Does pulsed field ablation reduce arrhythmia recurrence compared to radiofrequency ablation in patients undergoing fluoroless, ICE-guided atrial fibrillation ablation?
In a fluoroless, ICE-guided workflow, pulsed field ablation achieved significantly better short-term rhythm control in paroxysmal AF and shorter procedure times compared to radiofrequency ablation.
Absolute Event Rate: 4.8% vs 13.1%
p-value: p=0.082
BACKGROUND: Pulsed field ablation (PFA) is an alternative energy source to radiofrequency ablation (RFA) for atrial fibrillation (AF) with favorable safety and efficiency; however, outcomes are dependent on technique, lesion density, and tissue-contact assessment. OBJECTIVE: To compare outcomes of AF ablation using PFA versus RFA when performed in an identical, fluoroless workflow incorporating electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) using the HALO (High-density Antral Left-atrial ICE-guided Overlapping) protocol. METHODS: Retrospective analysis of 192 patients undergoing AF ablation guided by LA ICE for contact assessment. PFA (n=62) employed high-density antral PV overlapping lesions, while RFA (n=130) combined ICE tissue enhancement with contact-force guidance. Lesion delivery was guided by spatial density and contact quality. RESULTS: Mean follow-up was 10.6 ± 4.3 months. Arrhythmia recurrence was lower with PFA (4.8%) than RFA (13.1%; 95% CI 0.09-1.15; p=0.082). In paroxysmal AF, recurrence was significantly lower with PFA (2.1%) versus RFA (15.8%; 95% CI 0.01-0.83; p=0.011). In persistent AF, recurrence rates were similar (p=0.569) despite a 3.5-fold higher proportion of redo procedures in the RFA group (p=0.001) and more frequent posterior wall (PW) isolation in the PFA group (46.8% vs 20.8%; p<0.001). Procedure duration was significantly shorter with PFA. No major complications occurred. CONCLUSIONS: In a standardized fluoroless HALO workflow, PFA achieved better short-term rhythm control in paroxysmal AF and significantly shorter procedure times. In persistent AF, outcomes were comparable with RFA. Lesion strategy and quality are critical determinants of ablation success beyond energy source selection alone.
Saad et al. (Mon,) conducted a cohort in Atrial fibrillation (n=192). Pulsed field ablation vs. Radiofrequency ablation was evaluated on Arrhythmia recurrence (95% CI 0.09-1.15, p=0.082). Pulsed field ablation yielded lower arrhythmia recurrence than radiofrequency ablation in paroxysmal AF (2.1% vs 15.8%; P=0.011), with similar outcomes in persistent AF.