Introduction

Atrial fibrillation often necessitates catheter ablation when antiarrhythmic drug therapy fails. Single-shot technologies using thermal energy, such as cryoballoon ablation, are commonly used, but pulsed field ablation (PFA), an innovative non-thermal ablation technique, is a potential alternative. This retrospective observational study aimed to compare the safety and efficacy of cryoballoon ablation and PFA in patients undergoing their first pulmonary vein isolation (PVI) procedure for atrial fibrillation treatment.

Methods

We utilised real-world data from patients who underwent PVI using cryoballoon ablation or PFA. The primary outcome encompassed procedural complications, including phrenic nerve palsy, cardiac tamponade, thromboembolic complications, bleeding complications and mortality. Secondary outcomes were procedural characteristics including procedure duration, length of hospital admission, and re-do ablation rates within 6 months.

Results

A total of 1714 procedures were analysed: 1241 in the cryoballoon group and 473 in the PFA group. Gender distribution (p = 0.03) and estimated glomerular filtration rate (p = 0.01) differed significantly. With regard to the primary outcome, the cryoballoon group demonstrated a higher incidence of phrenic nerve palsy compared with the PFA group (15 vs 0; p = 0.02). The procedure duration was shorter in the PFA group, even after adjusting for baseline characteristics (95.0 vs 74.0 min; p < 0.001). After adjustment for baseline characteristics, admission duration differed between the groups as well (p = 0.04).

Conclusion

The study results supported the safety and efficacy of PFA over cryoballoon ablation for PVI, highlighting advantages such as shorter procedure duration and absence of phrenic nerve palsy.

中文翻译：

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脉冲场与冷冻球囊消融治疗心房颤动：关于手术结果和疗效的真实观察研究

介绍

当抗心律失常药物治疗失败时，心房颤动通常需要导管消融。使用热能的单次技术（例如冷冻球囊消融）很常用，但脉冲场消融（PFA）这种创新的非热消融技术是一种潜在的替代方案。这项回顾性观察研究旨在比较冷冻球囊消融和 PFA 对于首次接受肺静脉隔离 (PVI) 手术治疗心房颤动的患者的安全性和有效性。

方法

我们利用了使用冷冻球囊消融或 PFA 进行 PVI 的患者的真实数据。主要结局包括手术并发症，包括膈神经麻痹、心包填塞、血栓栓塞并发症、出血并发症和死亡率。次要结局是手术特征，包括手术持续时间、住院时间和 6 个月内重做消融率。

结果

总共分析了 1714 例手术：冷冻球囊组 1241 例，PFA 组 473 例。性别分布 ( p  = 0.03) 和估计肾小球滤过率 ( p  = 0.01) 存在显着差异。关于主要结局，与 PFA 组相比，冷冻球囊组的膈神经麻痹发生率更高（15 vs 0；p  = 0.02）。即使在调整基线特征后，PFA 组的手术持续时间也较短（95.0 分钟 vs 74.0 分钟；p  < 0.001）。调整基线特征后，各组之间的入院持续时间也存在差异 ( p  = 0.04)。

结论

研究结果支持 PFA 相对于冷冻球囊消融术治疗 PVI 的安全性和有效性，突出了手术持续时间较短和不存在膈神经麻痹等优点。