Ma Chengming, Xiao Xianjie, Chen Qian, Li Wenwen, Wang Zhongzhen, Dai Shiyu, Sun Yuanjun, Xia Yunlong, Gao Lianjun, Yin Xiaomeng
Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Graduate School, Dalian Medical University, Dalian, China.
Front Cardiovasc Med. 2025 Feb 24;12:1501716. doi: 10.3389/fcvm.2025.1501716. eCollection 2025.
Whether the intraprocedural anticoagulation regimen and activated clotting time (ACT) in pulsed field ablation (PFA) for atrial fibrillation (AF) are the same as those for radiofrequency catheter ablation (RFCA) is currently unknown.
Our retrospective study included 51 paroxysmal AF patients who underwent PFA (PFA group) and were matched with paroxysmal AF patients who underwent RFCA. Nearest-neighbor propensity score matching was performed at a 1:1 ratio (no tolerance to anticoagulant regimens and a tolerance of 0.02 on the CHADS-VASc score, left atrial diameter, and left ventricular ejection fraction). Compared with the RFCA group, the PFA group had a significantly shorter procedure time but a longer fluoroscopy time. In both groups, an initial heparin dose of 110 U/kg was given. The 30-min ACT in the PFA group (240 ± 95.5 s) was shorter than that in the RFCA group (294.4 ± 82.3 s, = 0.003). The 60-, 90-, and 120-min ACTs were significantly longer in the PFA group. The percentage of 30 min-ACTs in the therapeutic range in the RFCA group (33.3%) was greater than that in the PFA group (15.7%, = 0.038). The time to achieve the target ACT was longer in the PFA group. There were no differences in the incidence of periprocedural thromboembolism or bleeding events between the two groups.
Compared with RFCA, PFA was associated with longer intraprocedural ACTs, shorter initial ACTs, fewer initial ACTs in the therapeutic range, and longer times to achieve the target ACT.
目前尚不清楚心房颤动（AF）脉冲场消融（PFA）术中抗凝方案及活化凝血时间（ACT）是否与射频导管消融（RFCA）相同。
我们的回顾性研究纳入了51例行PFA的阵发性AF患者（PFA组），并与行RFCA的阵发性AF患者进行匹配。采用1:1的最近邻倾向评分匹配（对抗凝方案无耐受性，CHADS-VASc评分、左心房直径和左心室射血分数的耐受性为0.02）。与RFCA组相比，PFA组手术时间显著缩短，但透视时间更长。两组均给予初始肝素剂量110 U/kg。PFA组30分钟ACT（240±95.5秒）短于RFCA组（294.4±82.3秒，P = 0.003）。PFA组60、90和120分钟ACT显著更长。RFCA组30分钟ACT在治疗范围内的百分比（33.3%）高于PFA组（15.7%，P = 0.038）。PFA组达到目标ACT的时间更长。两组围手术期血栓栓塞或出血事件的发生率无差异。
与RFCA相比，PFA术中ACT更长，初始ACT更短，初始ACT在治疗范围内的次数更少，达到目标ACT的时间更长。
