Clinical Outcomes of Pulsed-Field Ablation vs Traditional Ablation in Drug-Resistant Atrial Fibrillation

Abstract

Background: Catheter ablation is a standard approach to treatment of drug-resistant atrial fibrillation (AF) and somehow, thermal ablation techniques, radiofrequency (RF) and cryoballoon, have a potential of collateral tissue damage. A new potentially safer and more effective, selective myocardial-targeted modality is pulsed-field ablation (PFA), which is an electroporation-based technique, is selected because it is non-thermal in nature and is thus safer in use than conventional and widely used methods like fOC.

Objective: To determine the clinical effects, safety and efficacy of PFA and conventional ablation procedures in patients with drug-resistant AF.

Method: Recent randomized trials and big prospective cohort researches were systematically searched and analyzed considering those published between 2020 and 2024. The main outcomes were PVI success, 12 months arrhythmia-free survival, and the complications. Secondary endpoints measured the procedure time, Fluoroscopy exposure, and non-repeat ablation.

Results:In literature, PFA has had similar or better success of acute PVI (>98%) compared to RF and cryoablation. PFA (7178) one-year arrhythmia-free survival was found to be significantly higher than traditional ablation (5865). The results of safety were in favor of PFA, with significantly fewer cases of esophageal injury, phrenic nerve palsy, and pulmonary vein stenosis. There was less time taken by the procedures and less usage of fluoroscopy. The repeat ablation rates were also less in the PFA patients.

Conclusion:PFA has shown better efficacies and better safety profile over traditional thermal ablation of drug-resistant AF. The results of these studies suggest that PFA may be developed as a successful next-generation ablation modality, which should be more widely adopted in clinical settings and followed up over a longer period of time.