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Comparative Study
. 2024 Jul 2;26(7):euae194.
doi: 10.1093/europace/euae194.

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)

Nico Reinsch  1   2 , Anna Füting  1   2 , Stefan Hartl  1   2 , Dennis Höwel  2   3 , Eva Rausch  1   2 , Yali Lin  1   2 , Karampet Kasparian  2   4 , Kars Neven  1   2
Affiliations
Comparative Study

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)

Nico Reinsch et al. Europace. .

Abstract

Aims: Pulsed field ablation (PFA) is a novel, non-thermal, cardiac tissue-selective ablation modality. To date, radiofrequency (RF)-guided high-power short-duration (HPSD) ablation represents the gold standard besides cryo-ablation for pulmonary vein isolation (PVI). This single-centre, retrospective study investigated the efficacy of PFA-PVI vs. HPSD-RF PVI in terms of single-procedure arrhythmia-free outcome and safety in a real-world setting.

Methods and results: Consecutive, paroxysmal atrial fibrillation (AF) patients who underwent PVI using PFA or HPSD-RF were enrolled. In group PFA, PVI was performed using a pentaspline PFA catheter. The ablation procedure in group HPSD-RF was performed with RF energy (45 W, ablation index). A total of 410 patients (group PFA, 201; group HPSD-RF, 209) were included. There was no difference between both groups regarding age, gender, and CHA2DS2-VASc score. The procedure time was significantly shorter in group PFA [61 (44-103) vs. 125 (105-143) min; P < 0.001]; fluoroscopy time and dose area product were significantly higher in group PFA [16 (13-20) vs. 4 (2-5) min; P < 0.01 and 412 (270-739) vs. 129 (58-265) μGym2; P < 0.01]. The overall complication rates were 2.9% in group PFA and 6.2% in group HPSD (P = 0.158). There was one fatal stroke in the PFA group. The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 85% with PFA and 79% with HPSD-RF (log-rank P = 0.160). In 56 repeat ablation procedures, the PV reconnection rate was 30% after PFA and 38% after HPSD-RF (P = 0.372).

Conclusion: Both PFA and HPSD-RF were highly efficient and effective in achieving PVI in paroxysmal AF patients. The arrhythmia-free survival is comparable. The PV reconnection rate was not different.

Keywords: Ablation index; Atrial fibrillation; High-power short-duration ablation; Pulmonary vein isolation; Pulsed field ablation.

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Conflict of interest statement

Conflict of interest: The authors of this manuscript have the following competing interests: authors have served as consultants and received lecture honoraria from Boston Scientific and Biosense Webster, Inc. (N.R., K.N.). All other authors have nothing to declare relating to the current work.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Kaplan–Meier analysis. The graph shows Kaplan–Meier estimates of freedom from any atrial tachyarrhythmia episodes lasting >30 s after a single procedure. AF, atrial flutter; AT, atrial tachyarrhythmia; HPSD, high-power short-duration; PFA, pulsed field ablation.
See this image and copyright information in PMC

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