Introduction
Pulsed-field (PF) ablation is an emerging non-thermal technique for atrial fibrillation (AF) ablation. This study compares baseline characteristics, procedural parameters, safety, and one-year outcomes of PF ablation versus conventional radiofrequency (RF) ablation.
Methods
This single-center, observational cohort study included consecutive patients undergoing AF ablation using PF (Farapulse, BSCI, USA) or RF energy (SmartTouch or QDot, Biosense Webster, USA). In paroxysmal AF, pulmonary vein isolation (PVI) only was performed. In non-paroxysmal AF, posterior wall and mitral isthmus ablation were systematically added in the PF group, while additional RF ablations were operator-dependent. Cavotricuspid isthmus ablation was performed in patients with typical atrial flutter. Follow-up included clinical visits and 24-hour Holter monitoring at 3, 6, 9, and 12 months.
Results
A total of 437 patients were analyzed (319 PF, 118 RF). Groups were broadly comparable, although RF patients were slightly older and more often male. Paroxysmal AF was more frequent in the RF group. Procedural time (60.2 ± 19.4 vs. 139.6 ± 54.3 min) and left atrial dwelling time (39.1 ± 13.2 vs. 103.6 ± 45.7 min) were significantly shorter with PF ablation (both p < 0.0001). Complications occurred in 11.3% of PF and 13.6% of RF patients. At 12 months, freedom from AF was achieved in 76.7% of PF and 72.5% of RF patients.
Conclusion
In this real-world cohort, PF ablation was associated with markedly shorter procedures, comparable safety, and slightly higher one-year sinus rhythm maintenance compared with RF ablation, supporting its effectiveness and efficiency in routine AF ablation.
