Comparision of pulsed field ablation vs. high power short duration-ablation for pulmonary vein isolation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: The newly introduced non-thermal pulsed field ablation (PFA) is a promising technology to achieve fast pulmonary vein isolation (PVI) with high acute success rates and comparable safety features. However, previous studies have shown that high power short duration ablation (HPSD) is also highly effective and fast to achieve PVI with potentially less AF recurrence. Data comparing PFA to HPSD-PVI is lacking. OBJECTIVE: This study compared procedural parameter and outcome using the novel PFA-PVI to HPSD-PVI in patients with paroxysmal or persistent atrial fibrillation (PAF/persAF). METHODS: Between 09/2021 and 10/2022 all consecutive patients undergoing de-novo PVI (PFA or HPSD) were included in this analysis. For PFA-PVI a shapeable (flower/basket shape) 5 spline 20 electrode catheter was used. For HPSD-PVI a power setting of 70W/7s (70W/5s at posterior wall) was considered as HPSD. Furthermore, a 3D mapping system was used. Follow-up consisted of out-clinic pts visit, teleconsultation, 48h Holter ECG and CIED interrogation if applicable. RESULTS: A total of 114 patients (57 PFA [17(30%) PAF; 40(70%) persAF 40(70%)] were included in this analysis. PVI was successful in all patients. The PFA group revealed a significantly shorter procedure duration (65±17 min vs. 95±23 min, p<0.01) but longer fluoroscopy time (PFA 15±5min and HPSD 12±3min; p<0.001). However, the overall fluoroscopy dosage was comparable between groups (PFA: 3484±2072mGy*cm2; HPSD: 3168±2346mGy*cm2; p=0.448). Two tamponades occurred in the PFA while in HPSD two pts suffered groin bleedings. At follow-up after three months (33±12 days) 46 PFA (80.7%) and 44 HPSD pts (77.2%) were free from atrial arrhythmia after a single procedure (p=0.819). One clinically non.significant PV stenosis occurred in the HPSD group. CONCLUSION: PFA and HPSD-PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit.