Pulsed field ablation resulted in similar 12-month recurrence rates compared to second-generation cryoballoon ablation for paroxysmal atrial fibrillation (26.9% vs 28.6%; P=0.821).
Cohort (n=82)
No
Does pulsed field ablation reduce recurrence or improve safety compared to second-generation cryoballoon ablation in patients with paroxysmal atrial fibrillation?
Pulsed field ablation demonstrates comparable 12-month efficacy and safety to second-generation cryoballoon ablation for paroxysmal AF, while significantly reducing fluoroscopy time.
Absolute Event Rate: 26.9% vs 28.6%
p-value: p=0.821
Abstract Objective This study aims to compare the safety and efficacy of pulsed field ablation (PFA) versus second-generation cryoballoon ablation (CBA) in treating paroxysmal atrial fibrillation (AF) and to explore factors associated with recurrence. Methods A retrospective analysis was conducted on 82 patients from our University, including 26 who underwent PFA between July 2022 and January 2023, and 56 who underwent CBA between 2019 and 2021. All patients had failed treatment with class I and/or III antiarrhythmic drugs and were undergoing their first AF ablation. Patients were followed for one year post-operation to compare procedural parameters, recurrence rates, and complications, and to analyze factors influencing AF recurrence. Results Baseline Characteristics: No significant differences were observed between the PFA and CBA groups in terms of age, gender, CHA2DS2-VASc score, hypertension, diabetes, ejection fraction (EF), or left atrial diameter (LAD) (P0.05). Procedural Parameters: The total procedure time was similar between PFA and CBA groups(91.69±27.91)minvs.(99.21±20.97)min,P=0.226,butPFAhadsignificantlyshorterX−rayexposuretime(16.89±7.69)minvs.(25.59±5.51)min,P0.05.(91.69±27.91)minvs.(99.21±20.97)min,P=0.226,butPFAhadsignificantlyshorterX−rayexposuretime(16.89±7.69)minvs.(25.59±5.51)min,P0.05. Recurrence Rates: At 12 months follow-up, 23 patients (28.0%) experienced recurrence, with 7 in the PFA group (26.9%) and 16 in the CBA group (28.6%), showing no significant difference (Log-Rank P=0.821). Complications: Only one complication occurred in the CBA group (phrenic nerve palsy), with no significant difference between groups (P0.05). Recurrence Factors: Age was an independent risk factor for early recurrence (OR=1.088, 95%CI=1.013～1.169, P=0.021), while early recurrence and LAD were independent risk factors for late recurrence (OR=3.448, 95%CI=6.803～16.667, P=0.000; OR=1.148, 95%CI=1.024～1.289, P=0.018, respectively). Conclusion PFA and CBA have comparable total procedure times, but PFA significantly reduces X-ray exposure time. The recurrence rates and overall complication rates are similar between PFA and CBA. Age is an independent risk factor for early recurrence, while early recurrence and LAD are independent risk factors for late recurrence.
Li et al. (Sat,) conducted a cohort in paroxysmal atrial fibrillation (n=82). Pulsed field ablation (PFA) vs. Second-generation cryoballoon ablation (CBA) was evaluated on Recurrence at 12 months (p=0.821). Pulsed field ablation resulted in similar 12-month recurrence rates compared to second-generation cryoballoon ablation for paroxysmal atrial fibrillation (26.9% vs 28.6%; P=0.821).