Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Abstract

BackgroundThe newly introduced nonthermal pulsed field ablation (PFA) is a promising technology to achieve fast pulmonary vein isolation (PVI) with high acute success rates and good safety features. However, previous studies have shown that very high power short duration ablation (VHPSD) is also highly effective and fast to achieve PVI with potentially less arrhythmia recurrence compared to conventional radiofrequency ablation. Data comparing PFA to VHPSD‐PVI is lacking.ObjectiveThis study compared procedural and outcome data for PFA‐PVI to VHPSD‐PVI in patients with paroxysmal or persistent atrial fibrillation (PAF/persAF).MethodsConsecutive patients undergoing de novo PVI (PFA or VHPSD) were included in this analysis. For PFA‐PVI a pentaspline 20 electrode catheter was used. For VHPSD‐PVI an enhanced irrigated catheter with a power setting of 70 W/7 s (70 W/5 s at posterior wall) was employed in conjunction with electro‐anatomical mapping. All procedures were performed in deep analgo‐sedation.ResultsA total of n = 114 patients (n = 57[50%] PFA, n = 17[30%] PAF; n = 40[70%] persAF) were included in this analysis. PVI was successful in all patients. The PFA group revealed a significantly shorter procedure duration (65 ± 17 min vs. 95 ± 23 min, p < 0.01) but longer fluoroscopy time (PFA 15 ± 5 min and VHPSD 12 ± 3 min; p < 0.001). At follow‐up after median 125 days (interquartile range: 109–162) n = 46 PFA (80.7%) and n = 44 VHPSD pts (77.2%) were free from atrial arrhythmia after a single procedure (p = 0.819).Two tamponades occurred in the PFA while in VHPSD two pts suffered groin bleedings. One clinically nonsignificant PV stenosis occurred in the VHPSD group.ConclusionPulsed‐field ablation and VHPSD‐PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia‐free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit. Compared to PFA VHPSD‐PVI might ensure information on left atrial substrate allowing to target concomitant secondary tachycardias.

Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping

“…Compared to both cryoballoon and RFC ablation, PFA significantly reduced procedure times in two non-randomized single-centre studies. 16 , 17 In the only randomized study investigating PFA vs. thermal ablation, PVI procedure duration with PFA was 105.8 ± 29.4 min and 123.1 ± 42.1 min using thermal ablation. 18 …”

Pulmonary vein isolation using pulsed field ablation vs. high-power short-duration radiofrequency ablation in paroxysmal atrial fibrillation: efficacy, safety, and long-term follow-up (PRIORI study)

“…This possible cause has been extensively discussed before. 20 , 22 , 31 Therefore, practice changed resulting in abandoning the use of this certain guidewire and the use of a J-tip guidewire instead. After switching to the J-tip guidewire, no further tamponades occurred in the PFA group.…”

Meta‐analysis of high‐power short‐duration versus cryoballoon ablation for atrial fibrillation

“…A fixed‐effect model was employed in cases of low heterogeneity; otherwise, a random‐effect model was used. We also planned a priori subgroup analysis based on (i) type of AF (paroxysmal, persistent), (ii) studies using ≥70 W and <70 W power in the HPSD group (the term “70 W/5 s” is commonly regarded as a very HSPD in various literature 14,15 ), (iii) studies using contact force sensing ablation catheters, and (iv) studies with ablation lesions in extra‐PV. Sensitivity analysis was also conducted based on the ablation of extra‐PV lesions (this may result in an elevation of both fluoroscopy and procedure duration) and a study that demonstrated a significant advantage for CBA patients 16 .…”