Key result
PFA increases left-sided antral lesion size by ~30% vs. cryoballoon with similar durability.
Why the study?
To compare the effectiveness, acute lesion geometry via 3D electroanatomic mapping, and chronic lesion durability of pulsed-field ablation versus cryoballoon ablation for pulmonary vein isolation in paroxysmal AF.
Does pulsed-field ablation compared to cryoballoon ablation improve acute lesion geometry and chronic pulmonary vein isolation durability in patients with paroxysmal atrial fibrillation?
RCT (n=50)
Single-blind
1:1
Yes
Does pulsed-field ablation compared to cryoballoon ablation improve acute lesion geometry and chronic pulmonary vein isolation durability in patients with paroxysmal atrial fibrillation?
Pulsed-field ablation creates broader acute antral lesions than cryoballoon ablation, but both modalities demonstrate similar chronic pulmonary vein isolation durability of approximately 62-63% per vein.
Answers are grounded in this paper and cite their sources.
PFA yields broader acute lesions than cryoballoon without superior chronic pulmonary vein durability; extends lesion geometry comparisons in paroxysmal AF.
BACKGROUND AND AIMS: The SINGLE SHOT CHAMPION multicenter trial compared the effectiveness of pulsed-field ablation (PFA) and cryoballoon ablation (CBA) for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). In a prespecified sub-study, post-ablation three-dimensional electroanatomic mapping (3D-EAM) was performed, and repeat-procedure mapping data were analyzed. METHODS: Patients were randomized 1:1 to fluoroscopy-guided PVI with PFA or CBA. The first 25 patients in each group underwent high-density 3D-EAM immediately after ablation. Acute PV isolation and lesion geometry were assessed using bipolar voltage thresholds of 0.1 mV, 0.2 mV, and 0.5 mV. Lesion durability was evaluated at clinically indicated repeat ablation. RESULTS: In acute post-ablation mapping, residual PV conduction was seen in 4/25 (16%) CBA patients and 0/25 PFA patients (P=0.11). Inadvertent posterior wall conduction block occurred after PFA in 3 (12%) patients with small atria (mean LA volume 30.7 ml). PFA created larger left-sided lesions (antral area <0.5 mV: 5.7 mm2 [IQR 4.6-6.5] vs 4.4 mm2 [IQR 2.5-5.5], P=0.026) and narrower posterior wall channels (14.0 mm [IQR 10.5-20.6] vs. 24.0 mm [IQR 19.1-26.9], P<0.001), indicating wide-antral isolation. At redo (n=48), durable PVI was seen in 4/26 (15%) PFA and 3/22 (14%) CBA patients and in 63/102 (62%) veins after PFA and 52/82 (63%) after CBA (P=0.88). CONCLUSION: Fluoroscopy- and electrocardiogram-guided PVI can result in incomplete PV isolation after CBA or unintentional posterior wall block after PFA. In the acute mapping cohort, PFA yielded broader left-sided lesions than CBA; in a separate redo cohort, chronic PV durability was similar for both modalities.
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Kueffer et al. (2026) conducted an RCT in Paroxysmal atrial fibrillation (n=50). Pulsed-field ablation (PFA) vs. Cryoballoon ablation (CBA) was evaluated on Acute antral lesion size around the left pulmonary veins (<0.5 mV area in mm2) (p=0.026). Pulsed-field ablation created broader antral left-sided lesions and narrower posterior wall channels compared to cryoballoon ablation, while chronic pulmonary vein durability was similar between modalities.
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