Pulsed field ablation for paroxysmal atrial fibrillation achieved shorter procedure times and lower complication rates (1.1%) compared to radiofrequency ablation (6.6%; p=0.003).
Cohort (n=859)
No
Does pulsed field ablation improve procedural efficiency and safety compared to cryoballoon and radiofrequency ablation in patients with paroxysmal atrial fibrillation?
In a real-world cohort, pulsed field ablation for paroxysmal atrial fibrillation demonstrated significantly shorter procedure and fluoroscopy times, as well as fewer complications, compared to cryoballoon and radiofrequency ablation.
Absolute Event Rate: 1.1% vs 6.6%
p-value: p=0.003
Abstract Background Pulmonary vein isolation (PVI) remains the cornerstone of rhythm control therapy in atrial fibrillation (AF). Over the past decades, catheter ablation technologies have evolved from conventional radiofrequency ablation (RFA), cryoballoon ablation (CBA) to the latest pulsed field ablation (PFA). Unlike thermal energy modalities, PFA selectively ablate myocardial tissue through irreversible electroporation, minimizing collateral injury to adjacent structures such as esophagus, phrenic nerve and pulmonary veins. This latest technologies has potential to shorten procedure times, enhance safety and maintain durable lesion formation. However, real world comparative data between PFA, CBA and RFA in paroxysmal atrial fibrillation (PAF) remain limited especially in our region in Southeast Asia. Purpose This retrospective cohort study compares procedural characteristics and acute outcomes of PFA, cryoballoon ablation (CBA), and radiofrequency ablation (RFA) for first time PVI in patients with paroxysmal AF (PAF) in a real-world tertiary centre cohort. Methods We retrospectively reviewed consecutive first-time PVI procedures for PAF between 2009–2024. Patients were grouped by ablation modality: PFA (n = 182), CBA (n = 555), and RFA (n = 122). Cases with missing data or concomitant left atrial appendage occlusion were excluded. Demographic, comorbidity, and procedural variables were compared using Kruskal–Wallis and chi-square tests with Bonferroni post-hoc correction. Results A total of 1,098 ablation procedures were screened, and 859 patients (78.2%) (mean age 62 years; 61.6% male).The PFA cohort was older and more comorbid (hypertension 71%, coronary artery disease 47%, diabetes 35%, dyslipidemia 48%; all p 0.001). Despite this, PFA achieved the shortest procedure and fluoroscopy times median 52.5 min (IQR 40–70) and 22.3 min (IQR 17–29.4) compared with CBA 93 (IQR 70-120) / 27.5 min (IQR 18.5-37.3) and RFA 160 (IQR 125-210) / 49.4 min (34.3-63.2) with significant p value 0.001. Overall procedural success was comparable (98% across all groups). Complications were lowest with PFA (1.1%) and highest with RFA (6.6%; p = 0.003), primarily pericardial effusion or tamponade. Conclusion In this 15-year single-centre experience, the largest real world dataset on atrial fibrillation ablation in Souteast Asia, PFA demonstrated superior procedural efficiency and safety versus both CBA and RFA. Despite being performed in an older and more comorbid population, PFA achieved shortest procedure and fluroscopy times while maintaining high acute proceural success. Importantly, complications were lowest with PFA, suggesting its favorable safety margin and reduced risk of thermal injury to surrounding structures. These findings position of PFA as a rapid , safe and effective option for PVI in PAF patients. Future multicentre prospective studies warranted to validate the long term efficacy, lesion durability and cost effectiveness.AF ablation PFA CBA RFADemographic and procedural comparison
Atan et al. (Mon,) conducted a cohort in Paroxysmal atrial fibrillation (n=859). Pulsed field ablation vs. Cryoballoon ablation and radiofrequency ablation was evaluated on Complications (p=0.003). Pulsed field ablation for paroxysmal atrial fibrillation achieved shorter procedure times and lower complication rates (1.1%) compared to radiofrequency ablation (6.6%; p=0.003).
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