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. 2025 Apr 30:59:101684.
doi: 10.1016/j.ijcha.2025.101684. eCollection 2025 Aug.

Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation

Corinne Isenegger  1   2 , Rebecca Arnet  1   2 , Fabian Jordan  1   2 , Sven Knecht  1   2 , Philipp Krisai  1   2 , Gian Völlmin  1   2 , Jonas Brügger  1   2 , David Spreen  1   2 , Nicolas Schaerli  1   2 , Behnam Subin  1   2 , Beat Schär  1   2 , Nicola Formenti  1   2 , Felix Mahfoud  1   2 , Christian Sticherling  1   2 , Michael Kühne  1   2 , Patrick Badertscher  1   2
Affiliations

Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation

Corinne Isenegger et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Current thermal energy sources such as cryoballoon (Cryo) ablation technology are associated with high rates of reconnected pulmonary veins (PV), especially in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) may represent a more suitable ablation modality for this patient population. This study aims to compare the efficacy, and safety of PFA and Cryo in patients undergoing a PVI only approach for persistent AF.

Method: Patients with persistent AF who underwent PVI at a tertiary referral center using either PFA or Cryo were consecutively enrolled.

Results: A total of 220 patients (median age 66 [60-72] years, 24 % female) were included out of which 113 patients (51 %) underwent PFA and 107 patients (49 %) Cryoablation. Median procedure duration, LA dwell time and fluoroscopy time were shorter in the PFA group: 49 [39-61] min vs 60 [49-75] min (p < 0.001), 34 [25-43] min vs 37 [31--53] min (p < 0.001), and 9 [[8], [9], [10], [11], [12], [13]] min vs 11 [[8], [9], [10], [11], [12], [13], [14], [15], [16]] min (p = 0.008). During a median follow-up of 365 days, recurrence-free survival was 72 % in the PFA group and 60 % in the Cryo group (pLog-rank = 0.079). The change in AF type from persistent AF to paroxysmal AF was more frequently observed after PFA than after Cryo (68 % vs 37 %; p = 0.011).

Conclusion: In patients with persistent AF undergoing a PVI only approach, PFA was associated with shorter procedural times and similar efficacy, with a higher frequency of regression from persistent to paroxysmal AF. Future studies are needed to evaluate the role of ablation strategies beyond PVI when using PFA.

Keywords: Atrial fibrillation; Cryoballoon ablation; Pulmonary vein isolation; Pulsed field ablation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Patrick Badertscher reports a relationship with University of Basel that includes: funding grants. Patrick Badertscher reports a relationship with Stiftung für Herzschrittmacher und Elektrophysiologie that includes: funding grants. Patrick Badertscher reports a relationship with Freiwillige Akademische Gesellschaft Basel that includes: funding grants. Patrick Badertscher reports a relationship with Schweizerische Herzstiftung that includes: funding grants. Patrick Badertscher reports a relationship with Johnson & Johnson that includes: funding grants. Patrick Badertscher reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. Patrick Badertscher reports a relationship with Boston Scientific Corporation that includes: speaking and lecture fees. Patrick Badertscher reports a relationship with Abbott that includes: speaking and lecture fees. Philipp Krisai reports a relationship with BMS-Pfizer that includes:. Philipp Krisai reports a relationship with Swiss National Science Foundation that includes: funding grants. Philipp Krisai reports a relationship with Schweizerische Herzstiftung that includes: funding grants. Philipp Krisai reports a relationship with Foundation for Cardiovascular Research Basel that includes: funding grants. Philipp Krisai reports a relationship with Machaon Foundation that includes: funding grants. Sven Knecht reports a relationship with Schweizerische Herzstiftung that includes: funding grants. Felix Mahfoud reports a relationship with German Cardiac Society that includes: funding grants. Felix Mahfoud reports a relationship with Deutsche Forschungsgemeinschaft that includes: funding grants. Felix Mahfoud reports a relationship with German Heart Foundation that includes: funding grants. Felix Mahfoud reports a relationship with Ablative Solutions Inc that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Amgen that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Astra-Zeneca that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Bayer that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Boehringer Ingelheim that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Inari that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Medtronic that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Merck that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with ReCor Medical that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Servier that includes: consulting or advisory and speaking and lecture fees. Felix Mahfoud reports a relationship with Terumo that includes: consulting or advisory and speaking and lecture fees. Christian Sticherling reports a relationship with Medtronic Advisory Board Europe that includes: board membership. Christian Sticherling reports a relationship with Boston Scientitic Advisory Board Europe that includes: board membership. Christian Sticherling reports a relationship with Biosense Webster that includes: consulting or advisory, funding grants, and speaking and lecture fees. Christian Sticherling reports a relationship with Biotronik that includes: consulting or advisory, funding grants, and speaking and lecture fees. Christian Sticherling reports a relationship with European Union’s FP7 program that includes: funding grants. Christian Sticherling reports a relationship with Abbott that includes: consulting or advisory and speaking and lecture fees. Christian Sticherling reports a relationship with Medtronic that includes: consulting or advisory and speaking and lecture fees. Christian Sticherling reports a relationship with Boston Scientific that includes: consulting or advisory and speaking and lecture fees. Christian Sticherling reports a relationship with Microport that includes: consulting or advisory and speaking and lecture fees. Michael Kuehne reports a relationship with Swiss National Science Foundation that includes: funding grants. Michael Kuehne reports a relationship with Schweizerische Herzstiftung that includes: funding grants. Michael Kuehne reports a relationship with Foundation for Cardiovascular Research Basel that includes: funding grants. Michael Kuehne reports a relationship with Pfizer that includes: funding grants. Michael Kuehne reports a relationship with Boston Scientific that includes: funding grants. Michael Kuehne reports a relationship with Bristol Myers Squibb Co that includes: funding grants. Michael Kuehne reports a relationship with Biotronik that includes: funding grants. Michael Kuehne reports a relationship with Daiichi Sankyo that includes: funding grants and speaking and lecture fees. Behnam Subin reports a relationship with Boston Scientific that includes: travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper].

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Kaplan-Meier curve comparing probability of recurrence-free survival over 1 year between the PFA group and the Cryo group. Cryo = Cryoballoon ablation; PFA = Pulsed-field ablation.
See this image and copyright information in PMC

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