Background:
Obesity is a major risk factor for atrial fibrillation (AF) and is associated with lower ablation success rates. Pulmonary vein isolation (PVI) using high-power short-duration (HPSD) or very high-power short-duration (vHPSD) radiofrequency energy has improved procedural efficiency, while pulsed field ablation (PFA) represents a novel non-thermal alternative with promising safety and efficacy profiles. This study compared PFA (Farapulse) with HPSD/vHPSD ablation in obese patients with AF.
Methods:
A total of 208 obese patients (BMI ≥ 30 kg/m²) undergoing PVI at Ostalb-Klinikum Aalen between 2019 and 2024 were retrospectively analyzed as a consecutive series. Sixty-six patients were treated with PFA and 142 with HPSD/vHPSD ablation. Continuous variables were compared using Student’s t-test or Mann–Whitney U test, as appropriate, and categorical variables using Chi-square or Fisher’s exact test.
Results:
Baseline demographics were similar between groups regarding age (65.2 ± 8.7 vs. 64.4 ± 10.5 years), BMI, AF type, and CHA₂DS₂-VASc score. PFA procedures were significantly shorter than HPSD/vHPSD ablations (34.2 ± 13.6 vs. 96.7 ± 32.0 min; p < 0.001). Fluoroscopy time (11.0 ± 4.8 vs. 11.2 ± 6.3 min; p = 0.842) and dose area product (1051 ± 691 vs. 1230 ± 965 cGy*cm²; p = 0.194) did not differ significantly. AF recurrence after the blanking period was lower in trend but not statistically significant (10.6% vs. 17.6%; p = 0.273). No major complications occurred in the PFA group, while the HPSD/vHPSD group showed one pseudoaneurysm, two groin hematomas, and two pericardial tamponades.
Conclusions:
In obese patients with AF, pulsed field ablation achieved comparable efficacy to HPSD/vHPSD radiofrequency ablation with markedly shorter procedure times and fewer complications. PFA represents a safe and efficient alternative for AF ablation in this high-risk population.
