Comparison of pulsed field ablation and cryoballoon ablation in atrial fibrillation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Pulmonary vein isolation (PVI) using cryoballoon (CB) catheter ablation has emerged as a cornerstone for treatment of atrial fibrillation (AF). Recently pulsed field ablation (PFA) has been introduced for PVI. First data show high acute and favorable long-term outcome. So far, data comparing these "single shot" devices is sparse. OBJECTIVE: This analysis sought to provide procedural and outcome data comparing PFA to CB PVI. Furthermore, potentially postprocedural discomfort was evaluated. METHODS: A retrospective analysis of PVI procedures using PFA or CB was performed. Discomfort analysis was obtained by prescribed analgesic medication within first 48 h after PVI (fully digital patient file). During follow-up (FU) repeat outpatient visits and Holter ECG were performed. RESULTS: In all 108 patients with AF (54 PFA and 54 CB; PFA: 37 (69 %) men; CB: 38 (70 %) men) successful PVI was achieved. There were no significant differences regarding baseline characteristics. 17 (31 %) patients in the PFA group and 18 (33 %) patients in the CB group had paroxysmal AF. Procedure time trended to be shorter in the PFA group (PFA: 64.5±17.5 minutes; CB: 73.0±24.8 minutes; p=0.07). Sub-analysis of the PFA group revealed a significant shortening of procedure duration over time (first 27 PFA vs. second 27 PFA: 72.9±19.1 minutes vs. 56.1±10.7 minutes, p=0.001). Significantly less contrast medium was used for PFA PVI as compared to CB PVI (PFA: 12± 6 ml; CB: 51± 29 ml, p<0.0001). Fluoroscopy time was significantly longer for PFA PVI (PFA: 15.3±4.7 minutes, CB: 12.3±5.3 minutes; p=0.001). Analysis of postprocedural analgesic medication demand did not differ between PFA and CB PVI (PFA: 7 patients; CB: 10 patients; p=0.59). After a FU of 234±127 days 79% of patients remained in SR after PFA and 78% after CB PVI (p=0.88). In the PFA group 2 non-device related cardiac tamponades occurred. CONCLUSION: A comparison of PFA to CB PVI revealed a comparable efficacy and safety profile with a steep learning curve and potentially shorter procedure duration. Amount of contrast medium is significantly higher for CB PVI. So far, arrhythmia-free survival seems to be still equal between both techniques. However, PFA is a safe and effective alternative to CB for PVI.