Safety and durability of PFA for pulmonary vein isolation: comparison to a reference RF data base

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Pulse field ablation (PFA) is a promising ablation technique for pulmonary vein isolation (PVI) with appealing advantages over RF including speed, tissue selectivity and the promise of enhanced durability. We determined procedural efficiency, safety and durability of PFA for PVI and compared its performance to a dataset of optimized radiofrequency (RF) ablation. METHODS: 180 consecutive patients with paroxysmal or persistent AF undergoing PFA-guided PVI (conventional basket and flower applications for each vein) were included and compared to 180 patients who underwent optimized high-power RF-guided PVI in experienced hands in the POWER-PLUS study. Endpoints were procedural efficiency, safety, and the incidence of 4 isolated veins as evaluated by comprehensive activation mapping at repeat procedure for recurrence. RESULTS: Median age was 66 years with 72% paroxysmal AF (clinical characteristics comparable to the RF group). PVI was obtained in all patients with a procedure time of 47min (vs 71min in RF, p < 0.0001) and fluoroscopy time of 14min (vs 11min in RF, p < 0.0001). One serious adverse event (TIA) occurred in a patient with thrombocytosis (1/180, 0.6% vs 0% in RF). No patient experienced pericarditis (vs 1 in RF). During a median follow-up in the PFA group of 4.8 [3.0; 6.4] months, 8 patients underwent repeat for recurrence which revealed a status of 4 isolated veins in a quarter of the patients (2/8, 25%). In the POWER-PLUS study, repeat ablation for recurrence revealed durable isolation of all veins in half of the patients (7/13, 54%, p between groups 0.2). By the time of the EHRA symposium, results will be presented for 6 months in both groups. CONCLUSION: PFA fulfills the promise of offering a short and safe PVI procedure, even when compared to optimized RF in experienced hands. Our data, showing PV reconnection as the dominant cause for recurrence, however temper the expectation of 100% durability. It remains to be seen, how operator expertise affects efficiency, safety, and durability of PFA.