Pulsed field ablation is time-saving irrespective of Body Mass Index compared to radiofrequency ablation even in obese patients

Malte Kranert (Tübingen)1, D. Heinzmann (Tübingen)1, C. Scheckenbach (Tübingen)2, M. Gawaz (Tübingen)1, J. Schreieck (Tübingen)1

1Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Kreislauferkrankungen Tübingen, Deutschland; 2Universitätsklinikum Tübingen Kinderkardiologie, Pulmologie, Intensivmedizin Tübingen, Deutschland



In obese patients with increased concomitant comorbidities like obstructive sleep apnea and higher risk of deep-sedation associated complications, procedure time can play a critical role in atrial fibrillation ablation. The single-shot attempt with cryoballoon pulmonary vein isolation (PVI) compared to radiofrequency PVI showed faster procedure time and tend to be as well effective and safe in Body Mass Index (BMI) > 30kg/m2.



In a single-center approach we compared PVI with pulsed-field ablation (PFA, Farapulse™) as well as radiofrequency ablation (RFA) (high-power short duration, HPSD, 50W) with special regard on procedure characteristics, testing the hypothesis of a safe and timesaving single-shot device in obese patients. When RFA was applied, a high density 3D Map was acquired in advance of ablation.


Methods and Results:

In a three year period, patients with paroxysmal and persistent AF (n=173) referred for first atrial fibrillation ablation were considered for analysis. PFA (n=78) showed faster procedure times, irrespective of BMI, compared to RFA (n=97). While there was a significant correlation between BMI and procedure time in RFA (r=0.228, p=0.033), there was none in PFA (r=0.104, p=0.360). (Figure 1) Likewise, radiation time exhibited no significant dependency to BMI, while radiation exposure did so. Peri- and postprocedural complications showed no significant difference in-between the groups.



Our analysis showed a significant reduction in procedure time of PFA compared to RFA in all patients, irrespective of BMI, while no significantly different safety issues occurred. Thus, PFA brings another single-shot device into the field of treating obese patients where time can play a major role to avoid sedation associated issues.

Figure 1:

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