High-power-short-duration-radiofrequency-, cryoballoon-, and pulsed-field-ablation: a prospective clinical study

Pulmonary vein isolation aims to reduce the burden of atrial fibrillation leading to symptom alleviation and improvement in quality of life. The newer pulsed-field ablation offers a non-thermal alternative to radiofrequency- and cryoballoon- ablation. We present one of the first clinical, pilot prospective comparisons of these three procedures with respect to freedom from recurrence up to one year, procedure safety, and assessment of quality of life. Localization of the pulmonary veins during pulsed-field ablation and radiofrequency ablation was supported by electroanatomical mapping, whereas only fluoroscopy was used for cryoballoon ablation. The ablation techniques also differed in terms of energy delivery. Pulsed-field ablation and cryoballoon ablation used a single-shot technique, while radiofrequency ablation used high-power, short-duration energies (50 W/10 Seconds) with point-by-point lesions. The study included 36 patients, 15 of whom were treated with pulsed-field ablation, 10 with high-power, short-duration radiofrequency ablation and 11 with cryoballoon ablation. Cryoballoon ablation showed the shortest ablation and catheter-dwell times. The fluoroscopy time and the dose area product were lowest for radiofrequency ablation. No recurrences of atrial fibrillation were recorded in the cryoballoon ablation group during the follow-up period, whereas 26.7% of participants in the pulsed-field ablation group and 30.0% in the radiofrequency ablation did. These differences, however, were not statistically significant. Quality of life showed a significant improvement in all three study groups. All three ablation procedures achieved the goal of reducing symptom burden with no statistically significant differences with respect to atrial fibrillation recurrence. Due to the great epidemiological significance of the disease, larger studies are needed to evaluate the success of the three ablation methods.