Pulmonary vein isolation using pulsed field ablation vs. high-power short-duration radiofrequency ablation in paroxysmal atrial fibrillation: efficacy, safety, and long-term follow-up (PRIORI study).

Autor:	Reinsch N; Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany.; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany., Füting A; Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany.; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany., Hartl S; Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany.; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany., Höwel D; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.; Department of Cardiology, St. Marienhospital Vechta, Vechta, Germany., Rausch E; Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany.; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany., Lin Y; Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany.; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany., Kasparian K; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.; Department of Oncology, Gastroenterology and Hematology, Alfried Krupp Krankenhaus, Essen, Germany., Neven K; Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany.; Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2024 Jul 02; Vol. 26 (7).
DOI:	10.1093/europace/euae194
Abstrakt:	Aims: Pulsed field ablation (PFA) is a novel, non-thermal, cardiac tissue-selective ablation modality. To date, radiofrequency (RF)-guided high-power short-duration (HPSD) ablation represents the gold standard besides cryo-ablation for pulmonary vein isolation (PVI). This single-centre, retrospective study investigated the efficacy of PFA-PVI vs. HPSD-RF PVI in terms of single-procedure arrhythmia-free outcome and safety in a real-world setting. Methods and Results: Consecutive, paroxysmal atrial fibrillation (AF) patients who underwent PVI using PFA or HPSD-RF were enrolled. In group PFA, PVI was performed using a pentaspline PFA catheter. The ablation procedure in group HPSD-RF was performed with RF energy (45 W, ablation index). A total of 410 patients (group PFA, 201; group HPSD-RF, 209) were included. There was no difference between both groups regarding age, gender, and CHA2DS2-VASc score. The procedure time was significantly shorter in group PFA [61 (44-103) vs. 125 (105-143) min; P < 0.001]; fluoroscopy time and dose area product were significantly higher in group PFA [16 (13-20) vs. 4 (2-5) min; P < 0.01 and 412 (270-739) vs. 129 (58-265) μGym2; P < 0.01]. The overall complication rates were 2.9% in group PFA and 6.2% in group HPSD (P = 0.158). There was one fatal stroke in the PFA group. The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 85% with PFA and 79% with HPSD-RF (log-rank P = 0.160). In 56 repeat ablation procedures, the PV reconnection rate was 30% after PFA and 38% after HPSD-RF (P = 0.372). Conclusion: Both PFA and HPSD-RF were highly efficient and effective in achieving PVI in paroxysmal AF patients. The arrhythmia-free survival is comparable. The PV reconnection rate was not different. Competing Interests: Conflict of interest: The authors of this manuscript have the following competing interests: authors have served as consultants and received lecture honoraria from Boston Scientific and Biosense Webster, Inc. (N.R., K.N.). All other authors have nothing to declare relating to the current work. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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