Pulsed-field ablation had significantly fewer thromboembolic events (0.5%) than radiofrequency ablation (5.8%), with no strokes after 1-month OAC cessation post-PFA.
Does pulsed-field ablation reduce thromboembolic events and allow earlier oral anticoagulation discontinuation compared to radiofrequency ablation in patients with atrial fibrillation?
Pulsed-field ablation is associated with significantly fewer thromboembolic events compared to radiofrequency ablation, suggesting that early discontinuation of oral anticoagulation at one month may be safe in arrhythmia-free patients.
Absolute Event Rate: 0% vs 0%
Abstract Background The endothelial injury that can promote thrombus formation during radiofrequency ablation (RFA) of atrial fibrillation (AF), does not happen with pulsed-field ablation (PFA). We evaluated different strategies for OAC management following PFA versus RFA. Methods Consecutive patients undergoing PFA were propensity score-matched with consecutive patients receiving RFA during the same time period (1:1) and prospectively followed-up for 15 months. Based on the duration of the oral anticoagulation (OAC) therapy, patients were classified into PFA/RFA-group 1: OAC for 1 month and PFA/RFA-group 2: OAC for ≥2 months. The RFA cohort was included as the ‘control’ group. Results A total of 800 patients were included in this analysis; PFA group: 400 (PFA-group 1: 196; PFA-group 2: 204) and RFA population: 400 (RFA-group 1: 182; RFA-group 2:218). At 15-month follow-up, 2 (0.5%) strokes were reported in the PFA population (none (0%) vs 2 (0.98%) patients in PFA-group 1 and 2 respectively). In the RFA cohort, 23 (5.8%) TE events were reported; 16 (8.8%) and 7 (3.2%) in group 1 and 2 respectively (p=0.017). Compared to the PFA population, total number of TE events were significantly higher in the overall RFA cohort (0.50% vs 5.8%, p 0.001) as well as in RFA-group 1 (0% vs 8.8%, p0.001). Arrhythmia-recurrence at 15-month was detected in 73 (18.25%) and 108 (27.0%) patients in the PFA and RFA cohort respectively (p=0.003) Conclusion The current study provided the first prospective data on stroke risk after discontinuation of oral anticoagulation following PFA vs thermal ablation. Significantly lower number of TE events were reported following PFA compared to the RFA group. Of note, no stroke was reported in the PFA population after discontinuation of oral anticoagulation at one month, which suggested early cessation to be safe in arrhythmia-free patients. However, due to rarity of AF-related stroke events, our findings need to be validated in larger multi-center studies.
Mohanty et al. (Sat,) reported a other. Pulsed-field ablation had significantly fewer thromboembolic events (0.5%) than radiofrequency ablation (5.8%), with no strokes after 1-month OAC cessation post-PFA.