Key result
PFA achieves similar 1-year arrhythmia freedom vs thermal ablation with shorter procedure times.
Why the study?
Pulsed field ablation has emerged as a novel non-thermal energy source to selectively ablate cardiac tissue, prompting comparison with thermal-based technologies for pulmonary vein isolation in paroxysmal atrial fibrillation.
Does pulsed field ablation improve procedural efficiency, safety, and 1-year freedom from atrial tachyarrhythmias compared to cryoballoon and radiofrequency ablation in patients undergoing first-time pulmonary vein isolation for paroxysmal atrial fibrillation?
Cohort (n=870)
Yes
Does pulsed field ablation improve procedural efficiency, safety, and 1-year freedom from atrial tachyarrhythmias compared to cryoballoon and radiofrequency ablation in patients undergoing first-time pulmonary vein isolation for paroxysmal atrial fibrillation?
In a propensity-matched cohort of paroxysmal AF patients, pulsed field ablation demonstrated comparable 1-year arrhythmia-free survival to cryoballoon and radiofrequency ablation, while offering significantly shorter procedural times, fewer minor thermal complications, and lower pulmonary vein reconnection rates at redo procedures.
Answers are grounded in this paper and cite their sources.
May support procedural efficiency of pulsed field ablation in paroxysmal AF; leaves open randomized confirmation of comparable 1-year outcomes.
AIMS: Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We describe a multicentre experience on pulmonary vein isolation (PVI) via the pentaspline Farapulse™ PFA system vs. thermal-based technologies in a propensity score-matched population of paroxysmal atrial fibrillation (PAF) patients. METHODS AND RESULTS: Propensity score matching was adopted to compare PVI-only ablation outcomes via the Farawave™ system (Group PFA), cryoballoon (Group CRYO), or focal radiofrequency (Group RF) (PFA:CRYO:RF ratio = 1:2:2). Among 1572 (mean age: 62.4 ± 11.3 years; 42.5% females) PAF patients undergoing first time PVI with either PFA (n = 174), CRYO (n = 655), or RF (n = 743), propensity score matching yielded 174 PFA, 348 CRYO, and 348 RF patients. First-pass isolation was achieved in 98.8% of pulmonary veins (PVs) with PFA, 81.5% with CRYO, and 73.1% with RF (P < 0.001). Procedural and dwell times were significantly shorter with PFA, whereas the availability of a 3D mapping system led to a significant reduction in X-ray exposure with RF. Overall complication rates were 3.4% (n = 6) with PFA, 8.6% (n = 30) with CRYO, and 5.5% (n = 19) with RF (P = 0.052). The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 79.3% with PFA, 74.7% with CRYO, and 72.4% with RF (log-rank P-value: 0.24). Among 145 repeat ablation procedures, PV reconnection rate was 19.1% after PFA, 27.5% after CRYO, and 34.8% after RF (P = 0.01). CONCLUSION: Pulsed field ablation contributed to significantly shorter procedural times. Follow-up data showed a similar arrhythmia freedom, although a higher rate of PV reconnection was documented in post-CRYO and post-RF redo procedures.
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Rocca et al. (2023) conducted a cohort in Paroxysmal atrial fibrillation (n=870). Pulsed field ablation (PFA) via the pentaspline Farapulse/Farawave system vs. Cryoballoon ablation (CRYO) or focal radiofrequency ablation (RF) guided by 3D-electroanatomical mapping was evaluated on 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia >30 s off anti-arrhythmic drugs occurring after the 3-month blanking period (p=0.24). Pulsed field ablation achieved similar 1-year freedom from atrial tachyarrhythmia compared to cryoballoon and radiofrequency ablation (79.3% vs 74.7% vs 72.4%, P=0.24), with shorter procedural times.
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