Pulsed-field vs. cryoballoon vs. radiofrequency ablation: a propensity score matched comparison of one-year outcomes after pulmonary vein isolation in patients with paroxysmal atrial fibrillation
Jens Maurhofer, Thomas Kueffer, Antonio Madaffari, Robin Stettler, Anita Stefanova, Jens Seiler, Gregor Thalmann, Nikola Kozhuharov, Oskar Galuszka, Helge Servatius, Andreas Haeberlin, Fabian Noti, Hildegard Tanner, Laurent Roten, Tobias Reichlin
Abstract
Abstract Background Pulsed-field ablation (PFA) has shown favourable data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI). We sought to compare procedural and 1-year follow-up data of patients with paroxysmal atrial fibrillation (AF) undergoing PVI using PFA, cryoballoon ablation (CBA) and radiofrequency ablation (RFA). Methods Consecutive patients with paroxysmal AF undergoing a first PVI with PFA at our institution were included. For comparison, patients with paroxysmal AF undergoing a first PVI with CBA and RFA were selected using a 1:2:2 propensity score matching. The PFA group followed the standard 32-applications lesion-set protocol, the CBA group a time-to-effect plus 2-min strategy, and the RFA group the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of atrial tachyarrhythmia (ATa) following a blanking period of 3 months. Results A total of 200 patients were included (PFA n = 40; CBA n = 80; RFA n = 80). Median procedure times were shortest with CBA (75 min) followed by PFA (94 min) and RFA (182 min ; p < 0.001). Fluoroscopy dose was lowest with RFA (1.6Gycm 2 ) followed by PFA (5.0Gycm 2 ) and CBA (5.7Gycm 2 ; p < 0.001). After a 1-year follow-up, freedom from ATa recurrence was 85.0% with PFA, 66.2% with CBA and 73.8% with RFA ( p = 0.12 PFA vs. CBA; p = 0.27 PFA vs. RFA). Conclusion In a propensity score matched analysis of patients with paroxysmal AF, freedom from any ATa 1 year after PVI using PFA was favourable and at least as good as for PVI with CBA or RFA. Graphical Abstract