Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Comparison of Pulsed Field Ablation and Cryoballoon Ablation in Atrial Fibrillation

J.-H. Schipper1, S. Dittrich1, S. C. R. Erlhöfer1, C. Scheurlen1, K. Filipovic1, J.-H. van den Bruck1, J. Wörmann1, F. Pavel1, J. Lüker1, D. Steven1, A. Sultan1

1Elektrophysiologie, Herzzentrum der Universität zu Köln, Köln;

Background Pulmonary vein isolation (PVI) using cryoballoon (CB) catheter ablation has emerged as a cornerstone for treatment of atrial fibrillation (AF). Recently pulsed field ablation (PFA) has been introduced for PVI. First data show high acute and favorable long-term outcome. So far, data comparing these “single shot” devices is sparse.   Objective This analysis sought to provide procedural and outcome data comparing PFA to CB PVI. Furthermore, potentially postprocedural discomfort was evaluated.   Methods A retrospective analysis of PVI procedures using PFA or CB was performed. Discomfort analysis was obtained by prescribed analgesic medication within first 48 h after PVI (fully digital patient file). During follow-up (FU) repeat outpatient visits and Holter ECG were performed.   Results In all 108 patients with AF (54 PFA and 54 CB; PFA: 37 (69 %) men; CB: 38 (70 %) men) successful PVI was achieved. There were no significant differences regarding baseline characteristics. 17 (31 %) patients in the PFA group and 18 (33 %) patients in the CB group had paroxysmal AF. Procedure time trended to be shorter in the PFA group (PFA: 64.5±17.5 minutes; CB: 73.0±24.8 minutes; p=0.07). Sub-analysis of the PFA group revealed a significant shortening of procedure duration over time (first 27 PFA vs. second 27 PFA: 72.9±19.1 minutes vs. 56.1±10.7 minutes; p=0.001). Significantly less contrast medium was used for PFA PVI as compared to CB PVI (PFA: 12± 6 ml; CB: 51± 29 ml; p<0.0001). Fluoroscopy time was significantly longer for PFA PVI (PFA: 15.3±4.7 minutes, CB: 12.3±5.3 minutes; p=0.001). Analysis of postprocedural analgesic medication demand did not differ between PFA and CB PVI (PFA: 7 patients; CB: 10 patients; p = .593). After a FU of 234±127 days 79% of patients remained in SR after PFA and 78% after CB PVI (p=0.88). In the PFA group 2 non-device related cardiac tamponades occurred.     Conclusion A comparison of PFA to CB PVI revealed a comparable efficacy and safety profile with a steep learning curve and potentially shorter procedure duration. Amount of contrast medium is significantly higher for CB PVI. So far, arrhythmia-free survival seems to be still equal between both techniques. However, PFA is a safe and effective alternative to CB for PVI.

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