Pulmonary Vein Isolation with Different Single-Shot Ablation Devices in Patients with Atrial Fibrillation: A Prospective Observational Single-Center Clinical Evaluation

Background and Objectives: The conventional technique for atrial fibrillation (AF) ablation has gradually been supplemented by ‘single-shot’ devices. Comparisons of devices using three different energy sources are rare. We aimed to evaluate the outcomes of patients with AF who underwent pulmonary vein isolation (PVI) using three various single-shot ablation techniques. We also examined factors associated with arrhythmia recurrence during the 12-month follow-up. Materials and Methods: We prospectively analyzed single-center data from consecutive adult patients undergoing PVI with different single-shot devices between January and December 2024. For cryoablation, a second-generation cryoballoon (AFA, Medtronic, Minneapolis, MN, USA) was used; for radiofrequency balloon ablation, the RFB catheter (Heliostar, Biosense Webster, California, CA, USA) was applied; and for the PFA-guided procedure, the Farawave (Boston Scientific, Massachusetts, MA, USA) ablation catheter was used. The procedural endpoint was to achieve intraoperative PVI. Arrhythmia recurrence was defined as any episode lasting >30 s documented by electrocardiographic recordings. Results: Ultimately, the analysis included 115 patients. Of these, 41 underwent PVI by cryoablation, 22 underwent RFB therapy, and 52 underwent PFA. The total skin-to-skin procedure time was the shortest among PFA-patients, primarily due to shorter left atrial dwell time. After 12 months of follow-up, 30 patients experienced recurrence of atrial arrhythmia. A larger left atrium diameter increased the risk of arrhythmia recurrence, whereas propafenone therapy at discharge was associated with a lower risk of recurrence during the 12-month follow-up. Conclusions: In this single-center observational study, PVI performed with PFA was associated with the shortest procedure time compared with procedures using CBA or RFB, with no difference in the risk of arrhythmia recurrence among the single-shot ablation modalities during the 12-month follow-up.