Introduction

Pulsed-field ablation (PFA) and the multi‐electrode radiofrequency balloon (RFB) are two novel ablation technologies to perform pulmonary vein isolation (PVI). It is currently unknown whether these technologies differ in lesion formation and lesion extent.

Purpose

We compared the acute lesion extent after PVI induced by PFA and RFB by measuring low-voltage area in high-density maps and the release of biomolecules reflecting cardiac injury.

Methods

PVI was performed with a pentaspline catheter (FARAPULSE) applying PFA or with the compliant multi‐electrode radiofrequency balloon (HELIOSTAR). Before and after PVI high-density mapping with CARTO 3 was performed. In addition, blood samples were taken before transseptal puncture and after post-PVI remapping and serum concentrations of high-sensitive Troponin I were quantified by immunoassay.

Results

60 patients undergoing PVI by PFA (n = 28, age 69 ± 12 y, 60 % males, 39.3 % persistent AF) or RFB (n = 32; age 65 ± 13 y, 53 % males, 21.9 % persistent AF) were evaluated. Acute PVI was achieved in all patients in both groups. Mean number of PFA pulses was 34.2 ± 4.5 and mean number RFB applications was 8.5 ± 3 per patient. Total posterior ablation area was significantly larger in PFA (20.7±7.7 cm²) than in RFB (7.1±2.09 cm²; p<0.001).Accordingly, posterior ablation area for each PV resulted in larger lesions after PFA vs. RFB (LSPV 5.2±2.7 cm² vs. 1.9±0.8 cm², LIPV 5.5±2.3 cm² vs. 1.9±0.8 cm², RSPV 4.7±1.9 cm² vs. 1.6±0.5 cm², RIPV 5.3±2.1 cm² vs. 1.6±0.7 cm² respectively; p<0.001)

In a subset of 38 patients increase of hsTropI was higher after PFA (625 ± 138 pg/ml, n = 28) vs. RFB (148 ± 36 pg/ml; n = 10; p = 0.049) supporting the evidence of larger lesion extent by PFA.

Conclusion

Pulse-field ablation delivers larger acute lesion areas and higher troponin release upon successful PVI than multi-electrode radiofrequency balloon-based PVI in this single-centre series.