Santos Rita Reis, Amador Rita, Santos Pedro Galvão, Matos Daniel, Rodrigues Gustavo, Carmo João, Costa Francisco, Carmo Pedro, Morgado Francisco, Cavaco Diogo, Scanavacca Mauricio, Adragão Pedro
Centro Hospitalar de Lisboa Ocidental Hospital de Santa Cruz, Carnaxide, Lisboa - Portugal.
Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2025 Mar 21;122(2):e20240542. doi: 10.36660/abc.20240542. eCollection 2025.
Pulmonary vein isolation (PVI) is crucial in treating symptomatic atrial fibrillation (AF). New ablation technologies, such as pulse-field ablation (PFA) and high-power short-duration (HPSD) have emerged in the electrophysiology lab. However, no study has compared the outcomes of these approaches.
To compare the efficacy and safety of PFA and HPSD in AF symptomatic patients.
Single-centre, retrospective study of consecutive patients undergoing PVI with PFA or HPSD between May and December 2022. Demographic data, procedural data, and AF recurrence beyond the blanking period, were analysed. Comparative analysis between both techniques was performed. A P-value of <0.05 was considered statistically significant.
A total 101 patients were included (61±11 years, 75% men); 56% of patients had paroxysmal AF and 19% underwent a redo ablation. Forty-five percent of patients underwent HPSD ablation and 55% PFA. Comparing HPSD and PFA, HPSD had a lower fluoroscopy time (5min [IQR 3-7min]vs 13min [IQR 10-16min], p<0.001), but higher procedure time (97min [IQR 75-142]vs 88min [IQR 66-111], p=0.13). Posterior wall isolation (PWI) was performed in 5 (11%) HPSD vs 20 (36%) PFA patients (p=0.004). There was only one case of major complication, a patient with cardiac tamponade following PFA, who was treated with pericardiocentesis. Over 384 (IQR 341 -545) days of follow-up, 76 patients (75%) were in sinus rhythm, while 25% of patients had AF recurrence: 10 PFA patients and 15 HPSD patients (p=0.06).
Both PFA and HPSD were found to be feasible and safe procedures. PFA resulted in shorter procedure times, and lower AF recurrence rates, mainly when PWI was performed. Although analysis in a real-world scenario is still scarce, both techniques seem to be efficient, with a low AF recurrence rate.
肺静脉隔离术（PVI）在有症状心房颤动（AF）的治疗中至关重要。新的消融技术，如脉冲场消融（PFA）和高功率短持续时间消融（HPSD）已在电生理实验室中出现。然而，尚无研究比较这些方法的疗效。
比较PFA和HPSD在有症状AF患者中的疗效和安全性。
对2022年5月至12月期间连续接受PFA或HPSD进行PVI的患者进行单中心回顾性研究。分析人口统计学数据、手术数据以及空白期后的AF复发情况。对两种技术进行比较分析。P值<0.05被认为具有统计学意义。
共纳入101例患者（61±11岁，75%为男性）；56%的患者患有阵发性AF，19%的患者接受了再次消融。45%的患者接受了HPSD消融，55%接受了PFA消融。比较HPSD和PFA，HPSD的透视时间较短（5分钟[四分位间距3 - 7分钟]对13分钟[四分位间距10 - 16分钟]，p<0.001），但手术时间较长（97分钟[四分位间距75 - 142]对88分钟[四分位间距66 - 111]，p = 0.13）。5例（11%）接受HPSD的患者与20例（36%）接受PFA的患者进行了后壁隔离（PWI）（p = 0.004）。仅发生1例主要并发症，1例PFA术后发生心脏压塞的患者，接受了心包穿刺治疗。在超过384天（四分位间距341 - 545天）的随访中，76例患者（75%）处于窦性心律，而25%的患者发生AF复发：10例PFA患者和15例HPSD患者（p = 0.06）。
PFA和HPSD均被证明是可行且安全的手术。PFA导致手术时间更短，AF复发率更低，主要是在进行PWI时。尽管在真实场景中的分析仍然较少，但两种技术似乎都有效，AF复发率较低。
