Kueffer, Thomas; Stettler, Robin; Maurhofer, Jens; Madaffari, Antonio; Stefanova, Anita; Iqbal, Salik Ur Rehman; Thalmann, Gregor; Kozhuharov, Nikola A; Galuszka, Oskar; Servatius, Helge; Haeberlin, Andreas; Noti, Fabian; Tanner, Hildegard; Roten, Laurent; Reichlin, Tobias (2024). Pulsed-field vs. Cryoballoon vs. Radiofrequency ablation: outcomes after pulmonary vein isolation in patients with persistent atrial fibrillation. Heart rhythm, 21(8), pp. 1227-1235. Elsevier 10.1016/j.hrthm.2024.04.045
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BACKGROUND
Pulsed-field ablation (PFA) has shown promising data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI), with similar long-term outcomes compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA) in patient with paroxysmal atrial fibrillation (AF) OBJECTIVE: To compare the procedural and long-term outcomes of patients with persistent AF undergoing PVI using PFA, CBA, or RFA.
METHODS
Consecutive patients with persistent AF undergoing a first PVI with PFA, CBA, or RFA were included. Patients underwent 7d-Holter-ECG at 3, 6, and 12 months post-ablation. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period. Safety outcomes included the composite of in-hospital major adverse events.
RESULTS
A total of 533 patients with persistent AF underwent PVI using PFA (n=214), CBA (n=190), or RFA (n=129). Procedures with PFA guided by fluoroscopy were shorter compared to CBA (median 60 min, IQR 53-80 vs. 84 min, IQR 68-101, p=<0.001), and procedures with PFA in combination with 3D-electroanatomical mapping were shorter compared to RFA (median 101 min, IQR 85-126 vs. 171 min, IQR 141-204, p<0.001). Acute safety events occurred in 2.3%, 2.6% and 0.8% in the PFA, CBA and RFA group (p=0.545). The 1-year confounder-adjusted estimate for freedom from atrial arrhythmias was 62.1% for CBA, 55.3% for PFA and 48.3% for RFA (CBA vs. PFA p=0.79, CBA vs. RFA p=0.009; PFA vs. RFA p=0.010).
CONCLUSION
In patients with persistent AF undergoing a first PVI, 1-year confounder-adjusted outcomes are better with PFA and CBA compared to RFA.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Kueffer, Thomas, Maurhofer, Jens Rudolf, Madaffari, Antonio, Stefanova, Anita, Iqbal, Salik Ur Rehman, Thalmann, Gregor, Kozhuharov, Nikola Asenov, Galuszka, Oskar Marian, Servatius, Helge Simon (B), Häberlin, Andreas David Heinrich, Noti, Fabian, Tanner, Hildegard, Roten, Laurent, Reichlin, Tobias Roman |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1547-5271 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
16 Apr 2024 09:40 |
Last Modified: |
02 Aug 2024 00:13 |
Publisher DOI: |
10.1016/j.hrthm.2024.04.045 |
PubMed ID: |
38614191 |
Uncontrolled Keywords: |
Pulmonary vein isolation cryoballoon ablation persistent atrial fibrillation pulsed-field ablation radiofrequency ablation |
BORIS DOI: |
10.48350/195963 |
URI: |
https://boris.unibe.ch/id/eprint/195963 |
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