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. 2024 Mar;67(2):389-397.
doi: 10.1007/s10840-023-01651-4. Epub 2023 Sep 30.

Pulsed-field vs. cryoballoon vs. radiofrequency ablation: a propensity score matched comparison of one-year outcomes after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Jens Maurhofer #  1 , Thomas Kueffer #  1 , Antonio Madaffari  1 , Robin Stettler  1 , Anita Stefanova  1 , Jens Seiler  1 , Gregor Thalmann  1 , Nikola Kozhuharov  1 , Oskar Galuszka  1 , Helge Servatius  1 , Andreas Haeberlin  1   2 , Fabian Noti  1 , Hildegard Tanner  1 , Laurent Roten  1 , Tobias Reichlin  3
Affiliations

Pulsed-field vs. cryoballoon vs. radiofrequency ablation: a propensity score matched comparison of one-year outcomes after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Jens Maurhofer et al. J Interv Card Electrophysiol. 2024 Mar.

Abstract

Background: Pulsed-field ablation (PFA) has shown favourable data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI). We sought to compare procedural and 1-year follow-up data of patients with paroxysmal atrial fibrillation (AF) undergoing PVI using PFA, cryoballoon ablation (CBA) and radiofrequency ablation (RFA).

Methods: Consecutive patients with paroxysmal AF undergoing a first PVI with PFA at our institution were included. For comparison, patients with paroxysmal AF undergoing a first PVI with CBA and RFA were selected using a 1:2:2 propensity score matching. The PFA group followed the standard 32-applications lesion-set protocol, the CBA group a time-to-effect plus 2-min strategy, and the RFA group the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of atrial tachyarrhythmia (ATa) following a blanking period of 3 months.

Results: A total of 200 patients were included (PFA n = 40; CBA n = 80; RFA n = 80). Median procedure times were shortest with CBA (75 min) followed by PFA (94 min) and RFA (182 min; p < 0.001). Fluoroscopy dose was lowest with RFA (1.6Gycm2) followed by PFA (5.0Gycm2) and CBA (5.7Gycm2; p < 0.001). After a 1-year follow-up, freedom from ATa recurrence was 85.0% with PFA, 66.2% with CBA and 73.8% with RFA (p = 0.12 PFA vs. CBA; p = 0.27 PFA vs. RFA).

Conclusion: In a propensity score matched analysis of patients with paroxysmal AF, freedom from any ATa 1 year after PVI using PFA was favourable and at least as good as for PVI with CBA or RFA.

Keywords: Cryoballoon ablation; Paroxysmal atrial fibrillation; Pulmonary vein isolation; Pulsed-field ablation; Radiofrequency ablation.

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Conflict of interest statement

J. S.: The spouse of Dr. Seiler is an employee of Boston Scientific and stock owner of Boston Scientific and Abbott. N. K.: Research grants from the Swiss National Science Foundation (P400PM-194477 and P5R5PM_210856), Gottfried und Julia Bangerter-Rhyner-Stiftung, Freiwillige Akademische Gesellschaft, L. & Th. La Roche Stiftung, and the European Society of Cardiology. A. H.: Travel fees/educational grants from Medtronic, Biotronik, Abbott, and Philips/Spectranetics without impact on his personal remuneration. He serves as a proctor for Medtronic. Research grants from the Swiss National Science Foundation, the Swiss Innovation agency Innosuisse, the Swiss Heart Foundation, the University of Bern, the University Hospital Bern, the Velux Foundation, the Hasler Foundation, the Swiss Heart Rhythm Foundation, and the Novartis Research Foundation. He is Co-founder and CEO of Act-Inno AG. F. N.: Medtronic, Abbott: Travel fees, speaker fees, educational grant; Boston Scientific, Philips Spectranetics: Travel fees, educational grant; Biotronik: Institutional grant all for work outside the submitted study. L. R.: Speaker honoraria from Abbott/SJM, consulting honoraria from Medtronic, and a research grant to the institution for an investigator-initiated trial from Medtronic. T. R.: Research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, and the sitem insel support funds, all for work outside the submitted study. Speaker/consulting honoraria or travel support from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific and Medtronic, all for work outside the submitted study. Support for his institution’s fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic for work outside the submitted study.

Figures

Fig. 1
Fig. 1
Study flowchart. AF atrial fibrillation, CBA cryoballoon ablation, PFA pulsed-field ablation, PVI pulmonary vein isolation, RFA radiofrequency ablation
Fig. 2
Fig. 2
Kaplan–Meier curves of freedom from any atrial tachyarrhythmia (atrial fibrillation / atrial flutter / atrial tachycardia) after the first pulmonary vein isolation using different technologies in patients with paroxysmal atrial fibrillation. CBA cryoballoon ablation, PVI pulmonary vein isolation, PFA pulsed-field ablation, RFA radiofrequency ablation
See this image and copyright information in PMC

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