Pulsed-field ablation versus single catheter high-power short-duration radiofrequency ablation for atrial fibrillation: procedural characteristics, myocardial injury and midterm outcomes

Funding Acknowledgements Type of funding sources: None. Background Pulsed-field ablation (PFA) has emerged as a novel treatment strategy for patients with atrial fibrillation (AF). A direct comparison to high-power short-duration (HPSD) radiofrequency (RF) ablation using a single catheter is lacking. Aim To compare pulmonary vein isolation (PVI) using PFA versus single catheter HPSD-RF ablation regarding efficiency, safety, myocardial injury, and outcomes. Methods 119 patients underwent PVI and were included (age 65.6 ± 10 years, ejection fraction 0.55 ± 0.11, left atrial size 41 ± 6.6 mm, paroxysmal AF 55%). 56 patients (47%) underwent PFA using a multi-electrode pentaspline PFA catheter with a biphasic waveform and 63 patients (53%) underwent single catheter HPSD-RF ablation without a multipolar mapping catheter. Results Using PFA the median procedure time was significantly shorter compared to the single catheter HPSD-RF group with 58 (IQR 51-70) min versus 83 (IQR 71-99) min (p<0.001), while fluoroscopic time was significantly longer with 12 (IQR 10-16) min versus 2.2 (IQR 1.3-3.6) min (p<0.001). First-pass isolation was achieved in 91% of the PFA group and 88% in the HPSD-RF group. 3.3 catheters vs. 1.0 catheters were used in the PFA group versus the HPSD-RF group, p<0.01. One procedural complications was observed in the PFA group and one complication in the HPSD-RF group (Tamponades). High sensitivity cardiac troponin levels were on average significantly higher in patients using the PFA system, 1520 (IQR 1010-1980) ng/l compared to 897 (IQR 725-1240) ng/l in the HPSD-RF group. During a median follow-up of 177 days (IQR 92-300), AF recurrence was observed in five patients (9%) from the PFA group and in 15 patients (24%) from the HPSD-RF group. (Figure 1) Conclusion PFA showed shorter procedure times but longer fluoroscopy times, higher levels of hs cTnT, and a possible improved AF-free survival.