Pulsed field vs very high-power short-duration radiofrequency ablation for atrial fibrillation: Results of a multicenter, real-world experience.

Autor:	Dello Russo A; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy., Compagnucci P; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy. Electronic address: paolocompagnucci1@gmail.com., Anselmino M; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy., Schillaci V; Clinica Montevergine, Mercogliano, Avellino, Italy., Campanelli F; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy., Ascione MR; Department of Medical Sciences, University of Turin, Turin, Italy; Clinica Montevergine, Mercogliano, Avellino, Italy., Volpato G; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy., Cipolletta L; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy., Parisi Q; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy., Valeri Y; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy., D'Angelo L; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy., Chiariello P; Santa Maria Incoronata Dell'Olmo Hospital, Cava Dei Tirreni, Italy., Casella M; Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy., Solimene F; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Clinica Montevergine, Mercogliano, Avellino, Italy.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Sep; Vol. 21 (9), pp. 1526-1536. Date of Electronic Publication: 2024 May 27.
DOI:	10.1016/j.hrthm.2024.05.042
Abstrakt:	Background: Pulsed field ablation (PFA) and very high-power short-duration (vHPSD) radiofrequency ablation are the most recently introduced technologies for atrial fibrillation (AF) ablation. The procedural performance, safety, and effectiveness of PFA vs vHPSD are currently unknown. Objective: The study aimed to compare PFA with vHPSD for the treatment of paroxysmal or persistent AF. Methods: We conducted an observational, multicenter study enrolling 534 consecutive patients (63 ± 9 years; 36% female) with paroxysmal (n = 368 [69%]) or persistent (n = 166 [31%]) AF undergoing ablation by either PFA (Farapulse; n = 192) or vHPSD (90 W/4 seconds; QDOT Micro; n = 342) between 2020 and 2023. Atrial tachyarrhythmia recurrence after a 1-month blanking period was the primary efficacy end point and was assessed both overall and in propensity score-matched patients. The primary safety end point was a composite of procedure-related complications. Results: Successful pulmonary vein isolation was achieved in all patients, with shorter procedure duration (PFA,70 minutes; vHPSD, 100 minutes; P < .001) but longer fluoroscopy time (PFA, 15 minutes; vHPSD, 7 minutes; P < .001) in the PFA group. PFA was associated with more frequent use of general anesthesia (P < .001). Primary safety outcome events occurred in 19 patients (3.5%), with similar prevalence in both groups (PFA, 4%; vHPSD, 3%; P = .745). After a median follow-up of 12 (9-12) months, survival free from recurrent atrial tachyarrhythmia was similar between the PFA and vHPSD groups, both overall (12-month estimate: PFA, 75%; vHPSD, 76%; log-rank P = .73) and in propensity score-matched patients (n = 342; 12-month estimate: PFA, 75%; vHPSD, 77%; log-rank P = .980). Conclusion: In a large, multicenter experience, PFA was associated with more common use of general anesthesia, shorter procedural times, and longer fluoroscopy exposure compared with vHPSD ablation, with both techniques displaying superimposable safety and efficacy. Competing Interests: Disclosures A.D.R. is a consultant for Abbott Medical. M.A. is a consultant for Biosense Webster and Boston Scientific, is a clinical proctor for Medtronic, and has received educational grants from Abbott. M.C. has received speaker honoraria from Biosense Webster. All other authors declare no conflicts of interest. (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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