Pulsed field ablation resulted in a significantly lower percentage of initial activated clotting times in the therapeutic range compared to radiofrequency catheter ablation (15.7% vs 33.3%).
Cohort (n=102)
No
Does pulsed field ablation alter intraprocedural activated clotting times compared to radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation?
Pulsed field ablation is associated with delayed achievement of target activated clotting times compared to radiofrequency ablation, suggesting a need for modified intraprocedural heparin dosing strategies.
Effect estimate: Difference -17.6% (95% CI -34% to -1.3%)
Absolute Event Rate: 15.7% vs 33.3%
p-value: p=0.038
Aims Whether the intraprocedural anticoagulation regimen and activated clotting time (ACT) in pulsed field ablation (PFA) for atrial fibrillation (AF) are the same as those for radiofrequency catheter ablation (RFCA) is currently unknown. Methods and results Our retrospective study included 51 paroxysmal AF patients who underwent PFA (PFA group) and were matched with paroxysmal AF patients who underwent RFCA. Nearest-neighbor propensity score matching was performed at a 1:1 ratio (no tolerance to anticoagulant regimens and a tolerance of 0.02 on the CHA 2 DS 2 -VASc score, left atrial diameter, and left ventricular ejection fraction). Compared with the RFCA group, the PFA group had a significantly shorter procedure time but a longer fluoroscopy time. In both groups, an initial heparin dose of 110 U/kg was given. The 30-min ACT in the PFA group (240 ± 95.5 s) was shorter than that in the RFCA group (294.4 ± 82.3 s, P = 0.003). The 60-, 90-, and 120-min ACTs were significantly longer in the PFA group. The percentage of 30 min-ACTs in the therapeutic range in the RFCA group (33.3%) was greater than that in the PFA group (15.7%, P = 0.038). The time to achieve the target ACT was longer in the PFA group. There were no differences in the incidence of periprocedural thromboembolism or bleeding events between the two groups. Conclusions Compared with RFCA, PFA was associated with longer intraprocedural ACTs, shorter initial ACTs, fewer initial ACTs in the therapeutic range, and longer times to achieve the target ACT.
Ma et al. (Mon,) conducted a cohort in Paroxysmal atrial fibrillation (n=102). Pulsed field ablation (PFA) vs. Radiofrequency catheter ablation (RFCA) was evaluated on Percentage of initial ACTs (30 min-ACT) in the therapeutic range (Difference -17.6%, 95% CI -34% to -1.3%, p=0.038). Pulsed field ablation resulted in a significantly lower percentage of initial activated clotting times in the therapeutic range compared to radiofrequency catheter ablation (15.7% vs 33.3%).