Pulsed-field ablation vs high-power short-duration radiofrequency in paroxysmal AF

A retrospective study showed shorter procedure time but higher fluoroscopy time with similar procedure complication rates and arrhythmia recurrence rates in participants with paroxysmal atrial fibrillation (AF) treated with pulsed-field ablation versus high-power short-duration radiofrequency ablation.

This retrospective study included participants with paroxysmal AF who received pulmonary vein isolation ablation in a single centre in Germany [1]. The analysis included 410 participants who received either pulsed-field ablation (n=201) or high-power short-duration radiofrequency (n=209; using the ablation index and CLOSE protocol). Outcomes were assessed over a 12-month follow-up period and included 5-day Holter-ECG assessments at 3, 6 and 12 months after ablation. Prof. Nico Reinsch (Alfried-Krupp-Hospital Rüttenscheid, Germany) presented the 1-year results.

Pulsed-field ablation versus high-power short-duration radiofrequency ablation led to significantly shorter procedural time (median 61 vs 125 min; P<0.001), left atrium dwell time (median 46 vs 110 min; P<0.001) but longer fluoroscopy time (median 16 vs 4 min; P<0.001). The incidence of procedural complications was similar between the two groups (2.9% vs 6.2%; P=0.159). After 12 months of follow-up, 85% of participants with pulsed-field ablation and 79% of participants with high-power short-duration radiofrequency ablation were free from any atrial tachyarrhythmia (P=0.160).

In this single-centre experience, pulmonary vein isolation using pulsed-field ablation showed “significantly shorter procedure times; however, fluoroscopy time and dosage were higher,” said Prof. Reinsch. Furthermore, “there was no significant difference in safety profiles between groups, and arrhythmia-free survival was similar after 1 year of follow-up”.

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   1. Reinsch N, et al. Pulmonary vein isolation using pulsed field ablation versus high-power-short-duration radiofrequency ablation for paroxysmal atrial fibrillation: efficacy, safety, and long-term follow-up. Atrial fibrillation: ablation 3. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202430 April 2024