Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison
Author:
Della Rocca Domenico G12ORCID, Marcon Lorenzo1ORCID, Magnocavallo Michele3ORCID, Menè Roberto4ORCID, Pannone Luigi1ORCID, Mohanty Sanghamitra2ORCID, Sousonis Vasileios4ORCID, Sorgente Antonio1ORCID, Almorad Alexandre1ORCID, Bisignani Antonio3ORCID, Głowniak Andrzej5ORCID, Del Monte Alvise1ORCID, Bala Gezim1ORCID, Polselli Marco3ORCID, Mouram Sahar1ORCID, La Fazia Vincenzo Fazia2ORCID, Ströker Erwin1ORCID, Gianni Carola2ORCID, Zeriouh Sarah4ORCID, Bianchi Stefano3ORCID, Sieira Juan1, Combes Stephane4ORCID, Sarkozy Andrea1ORCID, Rossi Pietro3ORCID, Boveda Serge4ORCID, Natale Andrea26ORCID, de Asmundis Carlo1ORCID, Chierchia Gian-Battista1ORCID, , Audiat Charles, Vetta Giampaolo, Cespón-Fernández María, Doundoulakis Ioannis, Monaco Cinzia, Overeinder Ingrid, Carette Gregory, Lombardo Ilenia, Nakasone Kazutaka, Eltzov Ivan, Meir Mark La
Affiliation:
1. Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart , Laarbeeklaan 101, 1090 Jette, Brussels , Belgium 2. St. David’s Medical Center, Texas Cardiac Arrhythmia Institute , 3000 N Interstate Hwy 35 Suite 720, Austin, 78705 TX, USA 3. Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola , Rome , Italy 4. Heart Rhythm Department, Clinique Pasteur , Toulouse , France 5. Department of Cardiology, Medical University of Lublin , Lublin , Poland 6. Case Western Reserve University School of Medicine , Health Education Campus, 9501 Euclid Ave, Cleveland, 44106 OH, USA
Abstract
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.
Publisher
Oxford University Press (OUP)
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