Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation

Abstract

Background: Current thermal energy sources such as cryoballoon (Cryo) ablation technology are associated with high rates of reconnected pulmonary veins (PV), especially in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) may represent a more suitable ablation modality for this patient population. This study aims to compare the efficacy, and safety of PFA and Cryo in patients undergoing a PVI only approach for persistent AF. Method: Patients with persistent AF who underwent PVI at a tertiary referral center using either PFA or Cryo were consecutively enrolled. Results: A total of 220 patients (median age 66 [60–72] years, 24 % female) were included out of which 113 patients (51 %) underwent PFA and 107 patients (49 %) Cryoablation. Median procedure duration, LA dwell time and fluoroscopy time were shorter in the PFA group: 49 [39–61] min vs 60 [49–75] min (p < 0.001), 34 [25–43] min vs 37 [31––53] min (p < 0.001), and 9 [8–13] min vs 11 [8–16] min (p = 0.008). During a median follow-up of 365 days, recurrence-free survival was 72 % in the PFA group and 60 % in the Cryo group (pLog-rank = 0.079). The change in AF type from persistent AF to paroxysmal AF was more frequently observed after PFA than after Cryo (68 % vs 37 %; p = 0.011). Conclusion: In patients with persistent AF undergoing a PVI only approach, PFA was associated with shorter procedural times and similar efficacy, with a higher frequency of regression from persistent to paroxysmal AF. Future studies are needed to evaluate the role of ablation strategies beyond PVI when using PFA.

Keywords

• Atrial fibrillation
• Pulsed field ablation
• Cryoballoon ablation
• Pulmonary vein isolation