Efficacy and Safety of Pulmonary Vein Isolation with Pulsed Field Ablation versus Novel Cryoballoon Ablation System for Atrial Fibrillation.

Background: Pulsed-field ablation (PFA) has emerged as a novel treatment technology for patients with atrial fibrillation (AF). Cryoballoon (CB) is the most frequently used single shot technology. A direct comparison to a novel CB system is lacking.
Objective: To compare pulmonary vein isolation (PVI) using PFA versus a novel CB system regarding efficiency, safety, myocardial injury, and outcomes.
Methods: 181 consecutive patients underwent PVI and were included (age 64 ± 9.7 years, ejection fraction 0.58 ± 0.09, left atrial size 40 ± 6.4 mm, paroxysmal AF 64%). 106 patients (59%) underwent PFA (FARAPULSE, Boston Scientific) and 75 patients (41%) underwent CB ablation (PolarX, Boston Scientific).
Results: The median procedure time, left atrial dwell time and fluoroscopic time were similar between the PFA and the CB group with 55 (IQR 43-64) min versus 58 (IQR 48-69) min (p < 0.087), 38 [30 - 49] min vs. 37 [31 - 48] min, (p = 0.871), and 11 (IQR 9.3-14) min versus 11 (IQR 8.7-16) min, (p < 0.81), respectively. Three procedural complications were observed in the PFA group (2 tamponades, 1 temporary ST elevation) and three complications in the CB group (3x reversible phrenic nerve palsies). During the median follow-up of 404 days (IQR 208-560), AF recurrence was similar in the PFA group and the CB group with 24% vs. 30%, p = 0.406.
Conclusion: Procedural characteristics were very similar between PFA and CB in regard to procedure duration fluoroscopy time and complications. AF free survival did not differ between the PFA and CB groups.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)