Comparison of pulsed field ablation and cryoballoon ablation for pulmonary vein isolation

• Published in: Journal of cardiovascular electrophysiology 2023-10, Vol.34 (10), p.2019-2026
• Main Authors: Schipper, Jan‐Hendrik, Steven, Daniel, Lüker, Jakob, Wörmann, Jonas, van den Bruck, Jan‐Hendrik, Filipovic, Karlo, Dittrich, Sebastian, Scheurlen, Cornelia, Erlhöfer, Susanne, Pavel, Friederike, Sultan, Arian
• Format: Article
• Language: English
• Subjects: Ablation; Analgesics; Arrhythmia; Autonomic ganglia; Cardiac arrhythmia; Contrast media; EKG; Fluoroscopy; Heart rate
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.16056

IntroductionPulmonary vein isolation (PVI) remains the cornerstone in the treatment of atrial fibrillation (AF). PVI using cryoballoon (CB) technology has emerged as a standard procedure in many centers. Recently, pulsed field ablation (PFA) has been introduced and used to achieve PVI. First data show high acute and favorable long‐term outcomes. So far, data comparing these new “single shot” devices are sparse. We sought to compare procedural and outcome data for first time PFA users versus CB in patients undergoing de novo PVI. Furthermore, potentially postprocedural discomfort and affection of autonomic ganglia were assessed.Methods and ResultsA retrospective analysis and comparison of all de novo PVIs with PFA and CB was performed. Furthermore, PFA PVI learning curve was evaluated. During follow‐up, repeat outpatient visits and Holter electrocardiogram were performed to analyze arrhythmia‐free survival. Discomfort analysis was obtained by prescribed analgesic medication within first 48 h after PVI. Potential changes in heart rate (HR) between baseline and at 3‐month follow‐up were evaluated. A total of 108 patients (54 PFA and 54 CB; PFA; 33 (30%) female) with paroxysmal and persistent AF were analyzed. Type of AF was comparable (Patients suffering from PAF: PFA: 16 (30%), CB: 17 (31%), p = 1.0). In 107 (99%) patients, successful PVI was achieved. Transient phrenic palsy omitted complete PVI in one CB patient. A trend for a shorter overall procedure duration was observed in the PFA group (PFA: 64.5 ± 17.5 min; CB: 73.0 ± 24.8 min; p = 0.07). Excluding LA mapping time (first 14 cases), procedure time was significantly shorter using PFA (PFA: 58.0 ± 12.5 min, CB: 73.0 ± 24.8 min, p = 0.0001). Fluoroscopy time was significantly longer for PFA (PFA: 15.3 ± 4.7 min, CB: 12.3 ± 5.3 min; p = 0.001), but significantly less contrast medium was used (PFA: 12 ± 6 mL; CB: 51 ± 29 mL, p