Procedural characteristics and acute outcomes with different pulsed field ablation systems for atrial fibrillation

BACKGROUND: Multiple different pulsed field ablation (PFA) systems have been developed for the treatment of atrial fibrillation (AF). An improved understanding of procedural workflow and outcomes are needed. METHODS: We performed a comparative observational study of consecutive patients undergoing PFA with three systems at a tertiary centre: Farawave without electroanatomic mapping (Boston Scientific, US), Faraview with integrated electroanatomic mapping (Boston Scientific, US) and Varipulse (Johnson and Johnson MedTech, US). All patients underwent pulmonary vein isolation (PVI) with additional lesions at operator discretion. RESULTS: A total of 150 patients undergoing PFA were included (50 with each system). Median age was 63-65 years (p = 0.28) and 28-38% female (p = 0.60). Persistent AF ranged from 40 to 62% (p = 0.09). More patients received posterior wall (PW) ablation with Faraview (50%) compared with Varipulse (26%) and Farawave (24%) (p = 0.01). Faraview was associated with more PV applications (52 versus 36; p < 0.001) although fewer PW applications (18 versus 24; p = 0.028) compared with Farawave. Procedure and left atrial catheter dwell times were higher with Varipulse compared with Farawave and Faraview (p < 0.001), but fluoroscopy time was lower (p < 0.001). Fluoroscopy use with Varipulse reduced in the second 25 cases compared with the first 25 cases (p = 0.01). There was no difference in rate of major or minor adverse events between groups. CONCLUSIONS: These real-world data on different PFA systems highlight varying procedural workflows depending on catheter design and the availability of additional information such as electroanatomic mapping and tissue contact. Further randomised studies are needed to compare safety and efficacy of different PFA systems for AF.