1Universitätsklinikum Frankfurt Med. Klinik III - Kardiologie, Angiologie Frankfurt am Main, Deutschland; 2Städtisches Klinikum Karlsruhe gGmbH Med. IV, Schwerpunkt Kardiologie, Angiologie und Internistische Intensivmedizin Karlsruhe, Deutschland
Background
Pulsed field ablation (PFA) has emerged as a new single shot ablation modality, offering non-inferior effectiveness, safety and even shorter procedure times compared to thermal modalities. Based on our previous work, where we showed that the rate of fibroblast activation seems to be more pronounced after pulmonary vein isolation (PVI) with cryoballoon ablation (CBA) compared to PFA, we hypothesized that the rate of occurrence of atypical atrial flutter might be lower after PFA PVI.
Methods
Baseline and periprocedural ablation data of 219 patients (141 PFA, 78 CBA) having undergone 1st-do PVI in 2 centers (University Hospital Frankfurt, Städtisches Klinikum Karlsruhe) for either paroxysmal or persistent atrial fibrillation (AF) were analyzed. Primary endpoint of our study was to observe the rate of atypical flutter or atrial tachycardia after PVI with PFA compared to CBA. Secondary endpoint was to observe the rate of AF recurrence in both groups.
Results
Mean patient age was 66.1±10.4 years. In the PFA group there were significantly more male patients than in the CBA group (70.9% vs. 50%, p<0.001). The other baseline characteristics like arterial hypertension, coronary artery disease, body mass index, CHA2DS2-VASc-score, history of stroke, left ventricular ejection fraction and left atrial diameter were well balanced within the groups. More of the patients treated with PFA tended to have persistent AF (46.1% vs. 27.2%) or were under the treatment with antiarrhythmic drugs (27.7% vs. 17.9%), without reaching the level of significance (Table 1). Mean follow-up was 191.8±96.3 days.
We observed numerically more cases of atypical atrial flutter after PVI with PFA than CBA (5.0% vs 2.6%) (Figure 1), while more cases of AF recurrence were observed after PVI with CBA than PFA (10.3% vs. 5.0%) (Figure 2). However, none of the outcomes were statistically significant.
Conclusion
Our study shows that the occurrences of both atypical atrial flutter and AF recurrence after PVI with PFA and CBA are comparable. However, our study included limited number of patients and limited duration of follow-up. Therefore, larger studies are needed to observe if there is a significant difference in the occurrence of AT/AF after PVI with these modalities as well as to observe if the individual mechanism of atrial flutter is different in PFA due to different method of cell death.
Table 1. Baseline and Procedural Characteristics
|
Ablation Modality (n) |
PFA (141) |
CBA (78) |
P |
|
Age, years |
66.9±10.8 |
65.9±11.7 |
0.25 |
|
Male, n (%) |
100 (70.9) |
39 (50.0) |
<0.001 |
|
Paroxysmal AF, n (%) |
76 (53.9) |
49 (62.8) |
0.47 |
|
LVEF, % |
53.5±11.8 |
54.1±15.4 |
0.48 |
|
LA Diameter, mm |
36.1±16.6 |
34.1±17.0 |
0.80 |
|
BMI, kg/m² |
28.7±5.6 |
28.2±4.5 |
0.79 |
|
Previous CTI, n (%) |
7 (5.0) |
9 (11.5) |
0.10 |
|
CHA2DS2-VASc-Score |
2.7±1.6 |
2.4±1.6 |
0.05 |
|
Stroke, n (%) |
15 (10.6) |
11 (14.1) |
0.51 |
|
CAD, n (%) |
28 (20.9) |
19 (24.4) |
0.49 |
|
A. Hypertension, n (%) |
105 (74.5) |
49 (62.8) |
0.08 |
|
Time from Diagnosis to PVI, Months |
31.4±47.3 |
44.6±60.9 |
0.05 |
|
Treatment with AAD at the baseline, n (%) |
39 (27.7) |
14 (17.9) |
0.14 |
|
Procedure Time, min |
77.6±29.3 |
68.6±37.1 |
0.06 |
PFA, pulsed field ablation; CBA, cryoballoon ablation; AF, atrial fibrillation, LVEF, left ventricular ejection fraction; LA, left atrium; BMI, body mass index, CAD, coronary heart disease; PVI, pulmonary vein isolation; AAD, antiarrhythmic drugs;
Figure 1. Freedom of atypical atrial flutter after PVI with PFA and CBA
Figure 2. Freedom of AF recurrence in PFA vs. CBA