Pulmonary vein isolation in atrial fibrillation: comparison between pulse field ablation and radiofrequency ablation

BACKGROUND The latest treatment innovation for the ablation of atrial fibrillation (AF) is a non-thermal energy source, pulsed field ablation (PFA), which has emerged as an alternative to radiofrequency ablation (RF) or cryoablation. OBJECTIVE We report a comparison of PFA with Farapulse system and RF ablation with both paroxysmal and persistent atrial fibrillation. METHODS The study is a retrospective study of transcatheter ablation data for paroxysmal or persistent AF treated with PFA or RF ablation. The primary efficacy outcome of the study was freedom from AF or Atrial flutter during follow-up after a 3-month blanking period. The primary outcome of safety included any complication during admission and in the first 30 days of follow-up. Secondary outcomes included total procedure time and fluoroscopic time. RESULTS The study included 659 patients underwent AF ablation. 196 patients underwent AF ablation by PFA, while the remainder underwent ablation with RF. After propensity matching based on 11 clinical and echocardiographic variables, 196 patient pairs were obtained, (mean age, 64±9 years; 115 (29.3%) women; 304 (77%) paroxysmal AF; with a good distribution of covariates between the study groups. Isolation of pulmonary veins was successfully achieved in all patients. Ablation of other structures was performed in 95 (24.2%), with similar rates in the PFA and RF groups. Procedural times were significantly shorter in the PFA group (PFA, 60 [50-70] minutes; RF, 100 [76-130] minutes; P < 0.0001). Fluoroscopy time was shorter in the RF group (PFA, 20 [15-23] minutes; RF, 7 [5-13] minutes; P < 0.0001). The complications was generally low: 2% in the PFA group, 1.5% in the RF group, with no significant differences between groups. After a median follow-up of 381 days (RF, 395 [198-973]; PFA 368 [251-430]) there were 58 arrhythmic recurrence events of atrial tachyarrhythmias (PFA, 30 [15.2%]; RF, 28 [14.3%]; P 0.882). CONCLUSION PFA today represents an increasingly popular technology. Numerous literature data have demonstrated that this technology is effective and safe for ablation of atrial fibrillation, significantly reducing procedural time.