Procedural efficiency and radiation exposure in high-power short-duration radiofrequency vs circular pulsed-field ablation for atrial fibrillation
J Conde Goncalves, B Cruz, A Lebreiro, M Miguel, E Oliveira, L AdaoAbstract
Background
High-power short-duration (HPSD) radiofrequency (RF) ablation achieves rapid lesion formation with limited thermal spread, while pulsed-field ablation (PFA) delivers non-thermal, tissue-selective energy. Comparative real-world data using systematic electroanatomic mapping remain scarce.
Purpose
To compare procedural efficiency and radiation exposure between HPSD-RF and circular PFA in atrial fibrillation (AF) ablation.
Methods
We prospectively enrolled consecutive patients undergoing AF ablation at a tertiary center. All procedures were guided by three-dimensional electroanatomic mapping with pre- and post-ablation voltage maps. Patients underwent either HPSD-RF ablation with a 4-mm irrigated-tip catheter or circular PFA. Procedural endpoints included total procedure time, fluoroscopy duration, and dose-area product.
Results
Forty patients (median age 59.5 years, 55% male) were included; baseline characteristics were comparable. HPSD-RF was used in 40% and PFA in 60%. Additional ablation beyond pulmonary vein isolation was performed in 25% (PFA) and 31.3% (HPSD-RF). Median procedure duration (90.5 vs 87.0 min, p=0.613), fluoroscopy time (4.25 vs 5.00 min, p=0.507), and radiation dose (15,947 vs 13,139 mGy·cm², p=0.207) did not differ significantly. No intraprocedural complications occurred.
Conclusion
In this prospective real-world cohort, circular PFA and HPSD-RF ablation demonstrated comparable procedural duration and radiation exposure when performed within a complete mapping workflow. In this setting, the choice between techniques should be driven by operator preference and long-term efficacy rather than procedural efficiency.