Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4

Pulsed field ablation for atrial fibrillation is associated with reduced radiation exposure in overweight patients compared to cryoballoon ablation

D. Vlachopoulou1, M. Rattka1, E. Mavrakis1, I. M. Rudolph2, J. Bohnen1, C. Jungen1, T. Rassaf1, S. Mathew1

1Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen; 2Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen;

Background: Pulmonary vein isolation (PVI) has become a cornerstone therapy in the treatment of atrial fibrillation (AF). Overweight is a known risk factor for the incidence and prevalence of atrial fibrillation and previous studies have shown that PVI for AF is feasible and safe in overweight and obese patients. However, overweight patients experience more AF recurrences following PVI, and are exposed to higher radiation dosages during the intervention. Pulsed field ablation (PFA) for PVI is a promising new non-thermal, tissue selective treatment approach, and a recent study has shown that efficacy and safety of PFA and cryoballoon ablation for PVI are comparable. Up to now there has been no study comparing the effect of different modalities for PVI on overweight patients suffering from AF. Methods: We included AF patients with a BMI > 25 kg/m2 undergoing either pulsed field ablation or cryoballoon ablation for atrial fibrillation. The time to atrial fibrillation recurrence, procedural parameters and periinterventional complications were compared. Results: We analyzed 115 overweight patients who underwent pulmonary vein isolation for atrial fibrillation by either pulsed field ablation (PFA group, 74 patients) or cryoballoon ablation (CBA group, 41 patients). 67 out of 115 patients (58.3%) had overweight (BMI > 25 kg/m2), while 48 out of 115 patients (41.7%) were obese (BMI > 30 kg/m2). Patients had a mean age of 64 years and were predominantly male (66.7%). Apart from a higher number of patients with known arterial hypertension in the CBA group (CBA group: 16 out of 41 patients, PFA group: 15 out of 74 patients; p=0.30) there were no significant differences in baseline characteristics. After a mean follow-up of 183±106 days, there was no significant difference in AF recurrences between both groups (log-rank test: p=0.355). At the end of follow-up 75% of patients with paroxysmal AF from the PFA group and 75% of patients from the CBA group, and 54% of PFA patients and 54% of CBA patients with persistent atrial fibrillation were still free from AF. There was no significant difference in periprocedural complications (p=0.709). Remarkably, analysis of the procedural parameters showed that radiation dose (CB group: 3351±2203 cGy·cm2, PFA group: 2447±1355 cGy·cm2; p=0.009) and the amount of contrast dye used (CB group: 156±87 ml, PFA group: 101±73 ml; p<0.001) were significantly lower in the PFA group, suggesting that PFA for AF might reduce radiation exposure for both overweight patients and their interventionalists. Multivariate logistic regressions analysis showed that obesity (HR 7.89, 95% CI 2.02-30.81; p=0.003) and PVI by CBA (HR 11.53, 95% CI 3.05-43.55; p<0.001) are independently associated with exceeding the diagnostic reference level of 4900 cGy·cm2 for complex electrophysiologic interventions, as recommended by the German Federal Office for Radiation Protection, thereby verifying out hypothesis. Conclusion: In our study we demonstrate that pulsed field ablation and cryoballoon ablation for pulmonary vein isolation in overweight patients suffering from atrial fibrillation show comparable results regarding rhythm outcome and complications. However, our results suggest that pulsed field ablation might be preferable over cryoballoon ablation in overweight patients since it is associated with lower radiation exposure, thereby protecting the health of both the patient and the interventionalist.

https://dgk.org/kongress_programme/ht2023/aP563.html