ISSN 2996-8215
International Journal of Cardiology | Vol. 13, No. 3, March 2022 | pp. 17–24
DOI: 10.46882/2022/IJC/000156
Original Research Article
Efficacy of Pulsed Field Ablation versus Cryoballoon Isolation for Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation
Guillaume Mercier¹, Pierre-Yves Roy¹, Jean-François Lebeau²
¹Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France
²Division of Cardiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Abstract:
Pulmonary vein isolation (PVI) is the cornerstone of interventional therapy for paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a novel non-thermal modality utilizing ultra-rapid electrical fields to selectively ablate myocardial tissue, minimizing collateral structural injury seen with thermal cryoballoon (CB) systems. This prospective randomized trial compared periprocedural parameters, safety profiles, and 12-month efficacy between PFA and CB isolation. We randomized 180 symptomatic patients with drug-refractory paroxysmal AF to undergo either multi-electrode PFA (n = 90) or standard CB ablation (n = 90). The primary efficacy endpoint was freedom from any documented atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period. Total procedure times were significantly shorter in the PFA cohort compared to the CB arm (64 ± 12 minutes vs. 88 ± 16 minutes, p < 0.001). Conversely, fluoroscopy times did not differ significantly (12.4 ± 3.1 minutes vs. 13.8 ± 3.5 minutes, p = 0.12). At 12 months, freedom from recurrent arrhythmia was achieved in 78.9% of the PFA group and 75.6% of the CB group (p = 0.58), confirming clinical non-inferiority. Phrenic nerve injury occurred in 4.4% of the CB group but was completely absent in the PFA arm (p = 0.04). Pulsed field ablation provides 12-month rhythm control efficacy equivalent to cryoballoon isolation while significantly enhancing procedural speed and eliminating collateral phrenic nerve complications.
Keywords: Atrial fibrillation, Pulmonary vein isolation, Pulsed field ablation, Cryoballoon ablation, Non-thermal ablation, Phrenic nerve safety
Received: December 10, 2021; Revised: January 20, 2022; Accepted: February 08, 2022; Published: March 19, 2022
Citation: International Journal of Cardiology, 2022, Vol. 13, No. 3, pp. 17–24, DOI: 10.46882/2022/IJC/000156