Abstract 4371049: Pulsed-Field vs Radiofrequency Ablation: Evaluation of Outcomes in Recurrent Atrial Fibrillation

Background: Pulsed-field ablation (PFA) has recently been approved in the USA as a new method for treating atrial fibrillation (AF). PFA provides a promising new approach in the treatment of atrial fibrillation (AF), which historically has a high recurrence rate post-ablation. Of significance, PFA has shown promising data in terms of safety and procedural efficiency to radiofrequency ablation (RFA). Objective: The purpose of this study was to compare the procedural and health outcomes in patients with recurrent AF undergoing ablation using PFA or RFA. Methods: Consecutive patients with a history of previous radiofrequency ablation and recurrent AF undergoing redo ablation with PFA or RFA were included. Patients were seen for follow-up in the clinic ranging from four months to a year and we reported ablation strategy and arrhythmia type. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period. Results: A total of 240 patients with recurrent AF underwent redo ablation using PFA (n = 54, 22.5%) or RFA (n = 186, 77.5%). Patients receiving PFA had an average age of 66 (SD ±11.7), were 69% male, and an average CHADSVASC score of 2.2 (SD ±1.61). This is similar to the demographic of patients receiving RFA, with an average age of 70 (SD ±12.95), 62.3% male, and average CHADSVASC of 3.06 (SD ±1.58). Procedures with PFA guided by fluoroscopy had an average fluoroscopy exposure time of 13.85 minutes compared to RFA procedures with 8.73 min (p = 6.313e-07). Fig 1 identifies the proportions of atrial arrhythmias ablated with each method. A high proportion of lesion sets utilized PVI (pulmonary vein isolation) along with other methods as shown in Fig 2. Of PFA patients who completed follow-up (n=30), 26% had a recurrence of AF. This was less than the 41% of RFA patients (n=49) followed who presented with AF recurrence (HR=0.22, CI 0.08-0.60, p=0.006). Conclusion: In patients with recurrent AF undergoing redo ablation, patients receiving PFA ablation presented with an 88% lower risk of recurrent AF compared to patients who received RFA.