Redo ablation for paroxysmal and persistent atrial fibrillation: long-term outcomes of high-power short-duration versus pulsed field ablation
A Padisak, G Orban, Z Sallo, I Osztheimer, E Tanai, P Perge, K V Nagy, P Toth, F Komlosi, I Szakal, B Merkely, L Geller, N SzegediAbstract
Background
Pulsed field ablation (PFA) and high-power short-duration (HPSD) ablation have recently been incorporated into clinical practice as novel technologies for performing pulmonary vein isolation (PVI).
Purpose
This study aimed to compare the procedural performance, safety, and long-term outcomes of PVI using PFA and HPSD in the treatment of paroxysmal and persistent atrial fibrillation (AF).
Methods
Consecutive patients undergoing redo AF ablation between July 2022 and October 2023 were retrospectively enrolled, regardless of the number of previous ablations. PFA was performed with the Farapulse catheter and HPSD ablation with the QDOT Micro catheter. The primary endpoint was freedom from electrocardiogram-documented atrial tachyarrhythmia recurrence and patient-reported symptoms. Recurrence was evaluated by 24-hour Holter monitoring at 3 and 24 months and at least once in between, with additional visits prompted by symptoms.
Results
A total of n=105 patients (63±10 years; 61% male) with paroxysmal (n=61 (58%)) or persistent (n=44 (42%)) AF were included in this analysis. PFA was performed in n=59 (56%) and HPSD ablation in n=46 (44%) patients. PVI was achieved in all patients, and all were in sinus rhythm at the end of the ablation. Procedure time was 61 [Interquartile range (IQR) 55-87] minutes in the PFA and 88 [IQR 62-100] minutes (p=0,085) in the HPSD group. Fluoroscopy time was 12 [IQR 10-16] and 9 [IQR 6-13] minutes (p=0,059) while left atrial time was 42 [IQR 34-59] and 44±20 minutes (p=0,603), respectively. In the HPSD group, four groin hematomas and one pericardial effusion were observed; in the PFA group, three hematomas, one pseudoaneurysm, and one pericarditis were reported. At 3-month follow-up, freedom from atrial tachyarrhythmia was n=47 (80%)) with PFA and n=38 (83%) with HPSD p=0,702; at 24 months, rates were n=39 (66%) and n=26 (57%) (p=0,316), respectively.
Conclusions
PFA and HPSD ablation showed comparable safety, acute and long-term efficacy for redo AF ablation.