One-year clinical and safety outcome of obese patients undergoing pulmonary vein isolation for atrial fibrillation with pulsed field ablation or cryoballoon ablation: A propensity-matched analysis.

BACKGROUND

Thermal-based ablation techniques, such as cryoballoon ablation (CBA), are widely used for pulmonary vein isolation (PVI) but show notable recurrence rates, particularly in obese patients. One possible reason is the reduced efficacy of thermal energy in tissues with significant epicardial fat, which can impede effective lesion formation and insulation of targeted areas.

OBJECTIVE

Pulsed-field ablation (PFA) has shown promising results for atrial fibrillation (AF) treatment, providing effective isolation with a favorable safety profile. This study investigates the clinical and safety outcomes of PFA compared with CBA in obese patients with AF.

METHODS

This retrospective propensity-matched study included symptomatic patients with paroxysmal and persistent AF and a body mass index (BMI) >30 who underwent PFA or CBA at a single institution. Matching criteria included age, left atrial diameter, left ventricular ejection fraction, and AF type (paroxysmal vs persistent), as well as preexisting conditions such as diabetes, coronary artery disease, and hyperlipoproteinemia. Procedural workflows were standardized, focusing on PV isolation. Outcomes assessed were procedural efficiency, recurrence rates, and complications.

RESULTS

Postmatching revealed lower recurrence rates in the PFA group (25%) compared with the CBA group (42.9%; P = .02). PFA was associated with significantly shorter left atrial (LA) time (33.8 min vs 49.7 min; P < .01) and procedural time (46.8 min vs 69.3 min, P < .01) than CBA, although fluoroscopy time showed no significant difference. Safety outcomes were similar across both groups.

CONCLUSION

PFA offers an alternative to CBA in obese patients, with superior recurrence outcomes and shorter procedural durations postmatching in this single-center cohort. PFA may be a preferred approach for AF management in this high-risk population. Future randomized trials are warranted to validate these findings and optimize treatment protocols for obese patients with AF.