Pulmonary vein isolation with radiofrequency ablation and pulsed-field ablation: follow-up with real-world data

Abstract

Introduction: Currently, the treatment of atrial fibrillation (AF) focuses on restoring sinus rhythm with pulmonary vein isolation (PVI). Pulsed‑field ablation (PFA) is a novel, promising method that requires greater support of real‑world data.

Objectives: Our aim was to assess the rate of arrhythmia recurrence in patients who underwent PVI with either radiofrequency (RF) energy or PFA.

Patients and methods: This retrospective analysis included 210 patients with paroxysmal (76.2%) or persistent AF undergoing PVI at a university hospital. The study group consisted of 108 patients who underwent PFA using the Farawave catheter. RF ablations were performed in 102 patients using a very‑high‑power, short‑duration or index‑guided ablation. The primary end point was no recurrence of arrhythmia.

Results: There were no significant baseline differences in patient characteristics. Procedural times were shorter with PFA (55 min) than RF (115 min; P <0.001), while fluoroscopy exposure duration was longer (PFA, 1100 s; RF, 159 s; P <0.001). In the patients who underwent PFA under deep sedation, remifentanil dose was lower than in the RF group under conscious sedation (PFA, 0.2 mg; RF, 0.5 mg; P <0.001). The efficacy of both methods did not differ in the recurrence rate of atrial arrhythmias during the blanking period (PFA, 32.7%; RF, 28.7%; P = 0.55) and afterward (PFA, 34.6%; RF, 33.7%; P >0.99). The overall frequency of adverse events was similar in both groups.

Conclusions: Regardless of the selected method, the efficacy of the procedures remains comparable. There was no significant difference in postoperative adverse events between the groups.