Pulsed-field- vs. Cryo- vs. Radiofrequency ablation: One-year recurrence rates after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background A multipolar pulsed-field ablation (PFA) catheter has recently been introduced and showed favorable data in terms of safety and procedural efficiency of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Long-term outcome data in comparison to other ablation modalities however is lacking. Purpose To compare procedural and one-year recurrence data of patients with paroxysmal AF (paroxAF) undergoing a first PVI using PFA, cryoballoon ablation (Cryo), or radiofrequency (RFA). Methods Consecutive patients with paroxAF undergoing a first PVI with PFA at our institution from May to December 2021 were included. For comparison, patients with paroxAF undergoing a first PVI with Cryo or RFA between May 2020 and March 2021 were included. A 3-D electro-anatomical mapping system was used in PFA and RFA, but not in Cryo. The following ablation protocols were used to achieve acute PVI: In the PFA group, the standard 32-applications lesion-set and supplementary applications at the discretion of the operator. In the Cryo group, a time-to-effect plus two minutes strategy and in the RFA group following to the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of any atrial arrhythmias following a blanking period of 3 months. Results A total of 202 patients were included (PFA: 32; Cryo: 82; RF: 88). Age, gender, CHA2DS2-VASc score, LVEF and LAVI did not differ among the groups (Table). Median procedure times were shortest with Cryo (76 [interquartile range 60-95] min) followed by PFA (94 [82-110] min) and RFA (157 [126-211] min, p < 0.01). Fluoroscopy dose was lowest with RFA (1.4 [0.6-2.5] Gycm2) followed by PFA (4.8 [3.5-7.9] Gycm2) and Cryo (5.3 [2.8-10.2] Gycm2, p < 0.01). Median follow-up time in patients without recurrence was 12 [10-12] months for the PFA group, 12 [12-13] months for the Cryo group and 13 [12-13] months for the RFA group. There was a trend towards fewer recurrences of atrial arrhythmias with PFA compared to Cryo and RFA (PFA 7%, Cryo: 25%, RFA: 20%, p = 0.13, Figure). Conclusion Recurrences of atrial arrhythmias 12 months after PFA PVI for paroxAF may be lower compared to Cryo and RFA. Larger prospective randomized studies are needed to confirm this initial experience.