Abstract Body (Do not enter title and authors here): Background
Pulsed-field ablation (PFA) has recently been approved in the USA as a new method for treating atrial fibrillation (AF). PFA provides a promising new approach in the treatment of atrial fibrillation (AF), which historically has a high recurrence rate post-ablation. Of significance, PFA has shown promising data in terms of safety and procedural efficiency to radiofrequency ablation (RFA).
Objective
The purpose of this study was to compare the procedural and health outcomes in patients with recurrent AF undergoing ablation using PFA or RFA.
Methods
Consecutive patients with a history of previous radiofrequency ablation and recurrent AF undergoing redo ablation with PFA or RFA were included. Patients were seen for follow-up in the clinic ranging from four months to a year and we reported ablation strategy and arrhythmia type. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period.
Results
A total of 240 patients with recurrent AF underwent redo ablation using PFA (n = 54, 22.5%) or RFA (n = 186, 77.5%). Patients receiving PFA had an average age of 66 (SD ±11.7), were 69% male, and an average CHADSVASC score of 2.2 (SD ±1.61). This is similar to the demographic of patients receiving RFA, with an average age of 70 (SD ±12.95), 62.3% male, and average CHADSVASC of 3.06 (SD ±1.58). Procedures with PFA guided by fluoroscopy had an average fluoroscopy exposure time of 13.85 minutes compared to RFA procedures with 8.73 min (p = 6.313e-07). Fig 1 identifies the proportions of atrial arrhythmias ablated with each method. A high proportion of lesion sets utilized PVI (pulmonary vein isolation) along with other methods as shown in Fig 2. Of PFA patients who completed follow-up (n=30), 26% had a recurrence of AF. This was less than the 41% of RFA patients (n=49) followed who presented with AF recurrence (HR=0.22, CI 0.08-0.60, p=0.006).
Conclusion
In patients with recurrent AF undergoing redo ablation, patients receiving PFA ablation presented with an 88% lower risk of recurrent AF compared to patients who received RFA.