Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland.
J Interv Card Electrophysiol. 2024 Mar;67(2):389-397. doi: 10.1007/s10840-023-01651-4. Epub 2023 Sep 30.
Pulsed-field ablation (PFA) has shown favourable data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI). We sought to compare procedural and 1-year follow-up data of patients with paroxysmal atrial fibrillation (AF) undergoing PVI using PFA, cryoballoon ablation (CBA) and radiofrequency ablation (RFA).
Consecutive patients with paroxysmal AF undergoing a first PVI with PFA at our institution were included. For comparison, patients with paroxysmal AF undergoing a first PVI with CBA and RFA were selected using a 1:2:2 propensity score matching. The PFA group followed the standard 32-applications lesion-set protocol, the CBA group a time-to-effect plus 2-min strategy, and the RFA group the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of atrial tachyarrhythmia (ATa) following a blanking period of 3 months.
A total of 200 patients were included (PFA n = 40; CBA n = 80; RFA n = 80). Median procedure times were shortest with CBA (75 min) followed by PFA (94 min) and RFA (182 min; p < 0.001). Fluoroscopy dose was lowest with RFA (1.6Gycm) followed by PFA (5.0Gycm) and CBA (5.7Gycm; p < 0.001). After a 1-year follow-up, freedom from ATa recurrence was 85.0% with PFA, 66.2% with CBA and 73.8% with RFA (p = 0.12 PFA vs. CBA; p = 0.27 PFA vs. RFA).
In a propensity score matched analysis of patients with paroxysmal AF, freedom from any ATa 1 year after PVI using PFA was favourable and at least as good as for PVI with CBA or RFA.
脉冲场消融（PFA）在安全性和程序效率方面为肺静脉隔离（PVI）提供了有利的数据。我们旨在比较使用 PFA、冷冻球囊消融（CBA）和射频消融（RFA）进行 PVI 的阵发性心房颤动（AF）患者的手术和 1 年随访数据。
本研究纳入了在我院接受首次 PFA 治疗的阵发性 AF 患者。为了进行比较，选择了接受首次 CBA 和 RFA 治疗的阵发性 AF 患者进行 1:2:2 倾向评分匹配。PFA 组遵循标准的 32 次应用病变集方案，CBA 组采用起效时间加 2 分钟策略，RFA 组采用 CLOSE 方案。患者在消融后 3、6 和 12 个月进行 7d-Holter ECG 随访。主要终点是 3 个月空白期后心房快速性心律失常（ATa）的复发。
共纳入 200 例患者（PFA 组 n=40；CBA 组 n=80；RFA 组 n=80）。CBA 的中位手术时间最短（75min），其次是 PFA（94min）和 RFA（182min；p<0.001）。RFA 的透视剂量最低（1.6Gycm），其次是 PFA（5.0Gycm）和 CBA（5.7Gycm；p<0.001）。1 年随访时，PFA 组 ATa 无复发率为 85.0%，CBA 组为 66.2%，RFA 组为 73.8%（p=0.12 PFA 与 CBA 相比；p=0.27 PFA 与 RFA 相比）。
在阵发性 AF 患者的倾向性评分匹配分析中，PFA 治疗阵发性 AF 患者的 1 年 PVI 后，无任何 ATa 的发生率良好，至少与 PVI 用 CBA 或 RFA 相当。
