Background:

Pulmonary vein isolation (PVI) is the cornerstone in the ablation of atrial fibrillation (AF). The novel pulsed field ablation (PFA) proved to be safe and effective for single-shot PVI. Very high-power short-duration ablation using dedicated radiofrequency catheters (vHPSD-RF) is a promising technique to achieve durable lesions within seconds in a point-by-point manner. The aim of this study was to compare these two new technologies with an emphasis on periprocedural parameters.

Methods:

Retrospective analysis of all patients (pts) with AF who underwent PVI in our center from 01.05.2022 to 17.05.2023 using PFA (FARAWAVE™, Boston Scientific, MA, USA) and vHPSD-RF (QDOT®, Biosense Webster, CA, USA). Primary endpoint was procedural success defined as isolation of all veins at the end of the procedure. A high-density (HD) mapping of the left atrium (LA) was performed in all patients before and after PVI. Skin-to-skin time, LA dwell time, fluoroscopy time and major complications were assessed. Major complications were defined as death, stroke or TIA, cardiac tamponade, atrial-esophageal fistula and vascular access complications requiring surgical intervention. Data were described as medians [1^st/3^rd Quartile] and evaluated by the Mann-Whitney-U Test and the Fisher’s exact test using SPSS.  

Results:

A total of 86 pts were included, thereof 47 pts received PFA and 39 pts received vHPSD-RF. The baseline characteristics are reported in Table 1. Complete isolation of all pulmonary veins was achieved in all pts (100%). Only one patient experienced a major complication (cardiac tamponade) after vHPSD-RF. Skin-to-skin time (64 [49-78] vs. 87 [74-104], p-value <0,001) and LA dwell time (41 [34-48,5] vs. 54,50 [42,25-64,50], p-value: 0,001) were significantly shorter in PFA (figures 1 and 2), while vHPSD-RF was associated with substantially shorter fluoroscopy time (14,8 [10,5-17,45] vs. 6,68 [3,52-10,37], p-value: <0,001) (figure 3). All PFAs were index PVI with no further ablation lesions. In the vHPSD-RF group, 19 pts (48,7%) had a previous PVI (redo PVI), and 21 pts (53,85%) had further ablation targets in addition to the PVI. After excluding redo-PVIs, the skin-to-skin time and the LA dwell time were still significantly shorter in PFA when compared to vHPSD-RF (64 [49-78] vs. 86,5 [71,25-110,5] and 41 [34-48,5] vs. 55 [37,25-63,75], p-values: <0,001 and 0,027 respectively).

Table 1:  Baseline characteristics

Conclusions:

In our single-center experience, PFA and vHPSD-RF were safe and effective. PFA is associated with significantly shorter procedure times, even if high-density (HD) mapping was used before and after PVI. PFA may become the ablation method of choice for index PVI. Despite the longer procedure times, vHPSD-RF had significantly lower fluoroscopy time. Unlike PFA, vHPSD-RF offers the advantage of addressing ablation targets beyond the pulmonary veins.

Disclosure statement: 
All authors declare no conflicts of interest.