Patient pain experience in pulmonary vein isolation: comparison cryoballoon versus pulsed field ablation
C Mages, P Syren, A K Rahm, C Brockmueller, P Schweizer, D Thomas, N Frey, P Lugenbiel, M ZyllaAbstract
Background
Pulmonary vein isolation (PVI) is the current state-of-the-art interventional treatment for atrial fibrillation (AF), but can be associated with periprocedural patient discomfort or pain. However, in light of same-day-discharge concepts, direct comparisons with established single-shot techniques like cryoballoon (CB) ablation and pulsed field ablation (PFA) regarding post-procedural pain perception are limited. This study systematically evaluates pain perception following a standardized deep sedation protocol in patients undergoing PVI with PFA or CB.
Methods
Patients with paroxysmal or persistent AF scheduled for PVI were prospectively enrolled and assigned for CB- or PFA- based PVI via clinical routine. Deep sedation was achieved with a combination of propofol, midazolam and fentanyl. Baseline characteristics, procedural data and additional required pain medication were assessed. Individual pain perception measured by the numeric rating scale (NRS) was recorded immediately after the procedure (T1), at 6-8hours (T2) and 8-24hours (T3) after procedure. Pain perception, pain localization and additional use of pain killer following AF ablation were compared between CB and PFA groups.
Results
A total of 101 consecutive patients undergoing PVI were included (CB n=51; PFA n=50)[Ga1] . Baseline parameters showed no statistically significant difference between the two groups (median age: 68 years (CB) vs. 67 years (PFA), P=0.812; median LA-size, 43mm (CB) vs. 44mm (PFA), P=0.156; female: 44% (CB) vs. 38% (PFA), P=0.542; paroxysmal AF: 72% (CB) vs. 76% (PFA) P=0.648). Median procedural duration was shorter in PFA procedures (61 min (CB) vs. 36 min (PFA), P<0.001). Median body weight corrected requirements of continuous propofol as well as single dose titrated midazolam and fentanyl was higher in the PFA group (propofol 0.094 mg/kg/min in PFA vs. 0.066 mg/kg/min in CB (P<0.001); midazolam 6.790x10-4 mg/kg/min in PFA vs. 4.929x10-4 mg/kg/min in CB (P<0.001) and fentanyl 3.630x10-5 mg/kg/min in PFA vs. 2.361x10-5 mg/kg/min in CB (P<0.001). Immediately after the procedure (T1) a total of 12% of all patients expressed pain without group differences (8% of PFA vs. 16% CB, P=0.357). During post-procedural evaluation there was no difference between CB and PFA groups in overall reported pain (T2: 36% PFA vs. 40% CB, P=0.837; T3: 76% PFA vs. 76% CB, P>0.999). Supplementary pain medication was rarely required (10% of PFA vs. 4% CB, P=0.436). Regarding localization of pain reported at T3, most patients described mild groin discomfort (Median NRS=2 both PFA and CB).
Conclusion
PFA was associated with higher procedural doses of analgesic medication when corrected for body weight and procedural time. However, individual pain perception as assessed by the NRS was both low after CB and PFA PVI and showed no significant difference. Supplementary pain medication use was rare.Pain perception after PVI