Pulsed Field Versus Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation: Efficacy, Safety, and Long-Term Follow-Up in a 400-Patient Cohort

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 16; no. 7; pp. 389 - 398
• Main Authors: Urbanek, Lukas, Bordignon, Stefano, Schaack, David, Chen, Shaojie, Tohoku, Shota, Efe, Tolga Han, Ebrahimi, Ramin, Pansera, Francesco, Hirokami, Jun, Plank, Karin, Koch, Alexander, Schulte-Hahn, Britta, Schmidt, Boris, Chun, Kyoung-Ryul Julian
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.07.2023
• Subjects: pulmonary vein; atrial fibrillation; catheter; myocardium; electroporation
• ISSN: 1941-3084; 1941-3149; 1941-3084
• DOI: 10.1161/CIRCEP.123.011920

The cryoballoon (CB) represents the gold standard single-shot device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Single-shot pulsed field PVI ablation (nonthermal, cardiac tissue selective) has recently entered the arena. We sought to compare procedural data and long-term outcome of both techniques. Consecutive AF patients who underwent pulsed field ablation (PFA) and CB-based PVI were enrolled. CB PVI was performed using the second-generation 28-mm CB; PFA was performed using a 31/35-mm pentaspline catheter. Success was defined as freedom from atrial tachyarrhythmia after a 3-month blanking period. Four hundred patients were included (56.5% men; 60.8% paroxysmal AF; age 70 [interquartile range, 59-77] years), 200 in each group (CB and PFA), and baseline characteristics did not differ. Acute PVI was achieved in 100% of PFA and in 98% (196/200) of CB patients ( =0.123; 4 touch-up ablations). Median procedure time was significantly shorter in PFA (34.5 [29-40] minutes) versus CB (50 [45-60] minutes; <0.001), fluoroscopy time was similar. Overall procedural complications were 6.5% in CB and 3.0% in PFA ( =0.1), driven by a higher rate of phrenic nerve palsies using CB. The 1-year success rates in paroxysmal AF (CB, 83.1%; PFA, 80.3%; =0.724) and persistent AF (CB, 71%; PFA, 66.8%; =0.629) were similar for both techniques. PFA compared with CB PVI shows a similar procedural efficacy but is associated with shorter procedure time and no phrenic nerve palsies. Importantly, 12-month clinical success rates are favorable but not different between both groups.