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. 2023 Dec 28;26(1):euae016.
doi: 10.1093/europace/euae016.

Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison

Domenico G Della Rocca  1   2 , Lorenzo Marcon  1 , Michele Magnocavallo  3 , Roberto Menè  4 , Luigi Pannone  1 , Sanghamitra Mohanty  2 , Vasileios Sousonis  4 , Antonio Sorgente  1 , Alexandre Almorad  1 , Antonio Bisignani  3 , Andrzej Głowniak  5 , Alvise Del Monte  1 , Gezim Bala  1 , Marco Polselli  3 , Sahar Mouram  1 , Vincenzo Fazia La Fazia  2 , Erwin Ströker  1 , Carola Gianni  2 , Sarah Zeriouh  4 , Stefano Bianchi  3 , Juan Sieira  1 , Stephane Combes  4 , Andrea Sarkozy  1 , Pietro Rossi  3 , Serge Boveda  4 , Andrea Natale  2   6 , Carlo de Asmundis  1 , Gian-Battista Chierchia  1 ; HRMC Investigators
Collaborators, Affiliations

Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison

Domenico G Della Rocca et al. Europace. .

Abstract

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.

Keywords: Atrial fibrillation; Atrial flutter; Cryoablation; Focal ablation; Pulsed field ablation; Radiofrequency; Single-shot.

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Conflict of interest statement

Conflict of interest: I have read the journal’s policy and the authors of this manuscript have the following competing interests. A.N. received speaker honoraria from Boston Scientific, Biosense Webster, Abbott, Biotronik, and Medtronic; and is a consultant for Biosense Webster, Abbott, and Janssen. G.-B.C. received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Boston Scientific, and Acutus Medical. C.d.A. receives research grants on behalf of the centre from Biotronik, Medtronic, Abbott, LivaNova, Boston Scientific, AtriCure, Philips, and Acutus. The other authors have declared that no competing interests exist.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Kaplan–Meier analysis. The graph shows Kaplan–Meier estimates of freedom from any atrial tachyarrhythmias (AF, AFlu, AT; panel A) and from documented AF (panel B) episodes lasting >30 s after a single procedure and off AAD therapy. AAD, anti-arrhythmic drug; AF, atrial fibrillation; AFlu, atrial flutter; AT, atrial tachycardia; CRYO, cryoballoon; PFA, pulsed field ablation; RF, radiofrequency.
Figure 2
Figure 2
Details on PV reconnection identified during redo procedures. (A) Percentage of PVs durably isolated or reconnected according to patient group. (B) Percentage of patients with durable PVI vs. those with one to four reconnected PVs per patient according to patient group. CRYO, cryoballoon; PFA, pulsed field ablation; PV, pulmonary vein; PVI, pulmonary vein isolation; Rec., reconnected; RF, radiofrequency.
See this image and copyright information in PMC

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