Arrhythmia recurrence after pulmonary vein isolation using radiofrequency ablation vs. pulsed field ablation

Abstract Background The widespread prevalence of atrial fibrillation (AF) has necessitated the exploration of novel methods for the control of heart rhythm. A relatively recent technique for pulmonary vein isolation (PVI) is pulsed field ablation (PFA), which selectively damage cardiomyocytes by delivering microsecond high-voltage currents. Real-world data is essential to explore the differences in efficacy between procedures performed using different approaches. Purpose The objective of the study was to evaluate the rate of arrhythmia recurrence in patients diagnosed with AF who underwent PVI using either radiofrequency energy (RF) or a technique based on electroporation. Methods This retrospective, single-center analysis included 210 patients with paroxysmal (76.2%) or persistent AF who underwent PVI in an academic hospital. 108 patients underwent PFA and 102 RF ablation, which were performed with a very-high-power, short-duration applications (performed with QDot MicroTM, Biosense Webster, Inc., Irvine, California, United States) or an ablation index-guided ThermoCool Smarttouch SF catheter (Biosense Webster, Inc.) while the PFA ones were performed with FarawaveTM Nav catheter (Boston Scientific). A primary end point was freedom from arrhythmia recurrence. Personal or telephone follow-up was collected at least 5 months after PVI. Consecutive patients were included into this analysis according to clinical criteria qualifying them for PVI procedure. Results There were no significant differences between patients’ characteristics like mean age in PFA and RF groups [PFA: 67 years (59-74) vs. RF: 67 years (61-72); p= 0.89] and sex [PFA: 41.7% females vs. RF: 43.1% females; p=0.89]. Procedural times were significantly reduced with PFA [55 min (45-70)] compared to RF [115 min (100-135)] (p<0.001), while duration of fluoroscopy exposure was notably longer [ PFA: 1100s (800-1400) vs. RF: 159s (88-335); p<0.001]. In patients who underwent PVI with PFA administered remifentanil [PFA: 0.2mg (0.15-0.3) vs. RF:0.5mg (0.3-0.6)] and heparin [PFA:18 IU (15-20) vs. RF: 21IU (17-24)] were lower than those required for RF ablation (p<0.001). The PFA procedures were performed under deep sedation and RF were performed under conscious sedation. The efficacy of the two methods did not differ by atrial arrhythmias recurrence rate during blanking period [PFA: 32.4% vs. RF: 28.4% p=0.55] and afterwards [PFA: 34.3% vs. RF 33.3%, p=1.0]. The overall reported adverse events occurred with similar frequency in both groups. Conclusion Regardless of the selected method, the efficacy of the procedure, and consequently the absence of arrhythmia recurrence, remains at a comparable level. There was no significant difference in occurrence postoperative adverse events between PFA and RF.The recurrences rates of arrhythmia