1Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Kreislauferkrankungen Tübingen, Deutschland; 2Universitätsklinikum Tübingen Kinderkardiologie, Pulmologie, Intensivmedizin Tübingen, Deutschland
Background:
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.
Aims:
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.
Conclusion:
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: