Very high-power short-duration ablation vs. cryoballoon for paroxysmal atrial fibrillation: a prospective single-center study with one-year follow- up

Introduction Pulmonary vein isolation (PVI) is the first-line treatment strategy for paroxysmal atrial fibrillation (PAF). Both radiofrequency ablation (RFA) and cryoballoon ablation (CBA) are well-established modalities for achieving durable PVI. Very high-power, short-duration (vHPSD) RFA has recently demonstrated favorable safety and efficiency profiles, yet prospective comparative data versus CBA remain limited. This study aimed to compare procedural characteristics and one-year outcomes between vHPSD RFA and CBA in patients with PAF. Methods In this prospective, single-center study, 164 consecutive patients undergoing PVI for PAF were included (vHPSD: n=76; CBA: n=88). Procedural parameters, complications, and 12-month arrhythmia-free survival were analyzed. Group comparisons were performed using t-tests and chi-square tests as appropriate. Results Procedural duration was significantly shorter with vHPSD compared to CBA (39.2 ± 8.8 min vs. 55.4 ± 13.8 min; p < 0.001). All vHPSD ablations were performed without fluoroscopy, resulting in markedly lower fluoroscopy time (0 s vs. 385.1 ± 158.3 s; p < 0.001) and radiation dose (0 mGy vs. 16.3 ± 9.7 mGy; p < 0.001). Baseline characteristics, complication rates, and 12-month arrhythmia recurrence (vHPSD: 8/76 vs. CBA: 16/88; p = 0.167) did not differ significantly between groups. Conclusion Very high-power, short-duration point-by-point RFA enables significantly shorter and radiation-free procedures compared with cryoballoon ablation, while providing comparable safety and one-year rhythm control outcomes.