COMPARISON OF PROCEDURAL WORKFLOW, SAFETY, AND ONE-YEAR EFFICACY OF CATHETER ABLATION OF ATRIAL FIBRILLATION USING RADIOFREQUENCY AND PULSED-FIELD ENERGY

Introduction
Pulsed-field (PF) ablation is an emerging technology in catheter ablation of atrial fibrillation (AF). This study sought to show a single-center comparison of procedural workflow in AF ablation using PF and radiofrequency (RF) energy. 

Methods
This is a single center, non-randomized, cohort, observational study. Ablation was performed using PF energy, or by RF energy. In paroxysmal patients, only PVI was done. In non-paroxysmal patients, also posterior wall and mitral isthmus ablation were performed in all patients in the PFA group. In the RF group, additional ablations beyond PVI were left on the discretion of the operator. All patients underwent 24-hour Holter monitoring and clinical check-up 3, 6, 9 and 12 months after AF ablation.

Results
A total of 159 patients were enrolled, 95 in the PFA and 61 in the RFA group. Despite non-randomized design, both groups were similar with respect from the baseline clinical characteristics (PFA vs RFA): age 63.1+11.3 vs. 64.5+10.9 years, BMI 29.7+5.2 vs. 30.2+5.1 kg/m2, 62 (65.3%) vs. 44 (72.1%) men, 51(53.7%) vs. 29 (47.5%) paroxysmal AF, 29 (30.5%) vs. 13 (21.3%) with history of heart failure, left ventricular ejection fraction 55.5% vs. 55.4% (all p=n.s.). Mean procedural time was shorter with PFA (60.2+18.6 vs. 144.9+61.2 min, p<0.001), as well as LA dwelling time (38.18+9.5 vs. 121.4+58.9 min, p<0.001). One major adverse event occurred in each group (cardiac arrest with a need for resuccitation and mechanical ventilation in the PFA, and one pericardial effusion in the RF group; 0.6 vs. 1.1%). AF freedom without any arrhythmia recurrence after 12 months follow up was present in 74.4% vs. 73.7 % patients.

Conclusion
Pulsed-field ablation using pentaspline catheter is asssociated with significantly shorter procedural time, similar safety and similar one-year efficacy, as compared to RF ablation