Why the study?
Preclinical studies yielded inconsistent results on how adipose tissue impacts pulsed field ablation, questioning its efficacy compared with radiofrequency ablation in patients with elevated epicardial adipose tissue.
Does pulsed field ablation reduce atrial fibrillation recurrence compared to high-power, short-duration radiofrequency ablation in obese patients with paroxysmal atrial fibrillation, and does epicardial adipose tissue volume predict recurrence?
Does pulsed field ablation reduce atrial fibrillation recurrence compared to high-power, short-duration radiofrequency ablation in obese patients with paroxysmal atrial fibrillation, and does epicardial adipose tissue volume predict recurrence?
In obese patients undergoing first-time ablation for atrial fibrillation, higher left atrial epicardial adipose tissue volume significantly predicts arrhythmia recurrence after pulsed field ablation but not after high-power, short-duration radiofrequency ablation.
PFA should not yet be preferred over RF in obese AF; leaves open randomized tests of the recurrence trend and EAT as a PFA-specific predictor.
Background Preclinical studies showed inconsistent results regarding the influence of adipose tissue on effective pulsed field ablation (PFA), raising questions about its efficacy in patients with elevated epicardial adipose tissue (EAT) levels. Objective Elevated EAT levels may lead to higher atrial fibrillation (AF) recurrence rates after pulmonary vein isolation using PFA than high-power, short-duration radiofrequency (RF) ablation. Methods 103 patients with body mass index of >29 kg/m 2 with paroxysmal or short-term persistent AF who underwent first-time AF ablation were prospectively enrolled (PFA n=41; RF n=62). All patients received preablation photon-counting computed tomography imaging to volumetrically quantify left and right atrial EAT levels. PFA was performed using a pentaspline catheter, and RF ablation was performed using high-power, short-duration energy. Results Median EAT volumes were 71.85 mL (interquartile range 50.35–93.35 mL) in the RF group and 65.61 mL (interquartile range 40.45–90.8 mL) in the PFA group ( P = .1352). Median follow-up was 367 days, excluding a 6-week blanking period. Atrial arrhythmia recurrence at 1 year was 33.87% in the RF group vs 17.07% in the PFA group ( P = .077). Cox regression showed that, in the PFA group, left atrial EAT was the only significant predictor of recurrence (hazard ratio 1.06; 95% confidence interval 1.01–1.12; P = .022), corresponding to a 6.2% increased risk per mL. In the RF group, left atrial EAT was not significantly associated with recurrence (hazard ratio 1.00; 95% confidence interval 0.97–1.03; P = .846). Conclusion PFA showed good 1-year results after pulmonary vein isolation in patients with a body mass index of >29 kg/m 2 . However, EAT may have a more significant impact on AF recurrences after PFA than RF ablation.
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Englert et al. (2025) studied this question.
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