Introduction: Pulsed field Ablation (PFA) promises to be an effective energy source for pulmonary vein isolation (PVI). Previous studies were able to show that PFA creates large and durable lesions. However, to date there is no comparative data between PFA and the established Cryoballoon. Thus, we sought out to compare the acute lesion sets achieved during a PVI with either the Cryoballoon (Medtronic??) or PFA (Farapulse).

Methods: We performed a single centre prospective study. A total of 30 consecutive patients referred to our centre for a primary PVI were included. For the study we performed intraprocedural prior and after PVI a high density 3-dimensional map of the left atrium using the Ensite Precision Cardiac Mapping System.  We than proceeded to compare the lesion sized achieved during PVI quantified by the percentage of points declared as scar (Voltage < 0.5mV). The Cryoablation was performed following a time to isolation (TTI) guided protocol, energy delivery was in general limited to 1 Freeze of 180s per vein if TTI was < 60s. PFA was performed using the Farapulse system: per vein 8 applications were performed (4 in basket configuration, 4 in the flower configuration), additional impulses were applied in case of non-achieved PVI.

Results: There were no differences in the study populations concerning the baseline characteristics (PFA vs. Cryo : mean age (years) 63 ± 6 vs. 61 ±  9 (p=0.46), CHA₂DS₂-Vasc 1.6 ± 1.5 vs. 1.2 ± 0.8 (p=0.052), left atrial volume index (LAVI)(ml/m²) 34 ± 11 vs. 34 ± 10 (p=0.47), ejection fraction (%) 59 ±  vs. 57 ± 3 (p=0.44). We saw 100% acute PVI in both groups. Concerning energy delivery, a mean of 741 s ± 98 s were applied in the Cryoballoon group and 80 s ± 15 s in the PFA group. One pericardial tamponade occurred in the PFA group and one transient phrenic nerve palsy in the Cryo group. Concerning left atrial low voltage areas, we saw no difference between both groups in pre ablation left atrial scarring (p=0.4). Comparing the lesion sizes achieved by PVI both groups showed no statistical differences (p=0.59).

Conclusions: In this first comparative study between Cryoablation and PFA technology for PVI we were able to show comparable sizes of the acute lesions with high acute success rates in both groups and very few complications.