Pulsed field versus cryoballoon ablation for atrial fibrillation – impact of energy source on sedation and analgesia requirement

Rahin Wahedi (Hamburg)1, S. Willems (Hamburg)1, M. Jularic (Hamburg)1, J. Hartmann (Hamburg)1, O. Anwar (Hamburg)1, J. Dickow (Hamburg)1, T. Harloff (Hamburg)1, N. Geßler (Hamburg)1, M. A. Gunawardene (Hamburg)1

1Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland


Background: Pulsed field ablation (PFA) has emerged as a novel technology that is increasingly applied for the catheter ablation (CA) of atrial fibrillation (AF) with similar efficacy to established, thermal energy sources. Data solely focussing on analgosedation compared to established single-shot modalities, such as cryoballoon (CB) ablation are scarce.

Aim: The aim of this study was to assess differences of analgosedation requirement, procedural cardiopulmonary stability, and analgosedation-associated complications between PFA and CB ablation. 

Methods: This study was a retrospective single-centre comparison of analgosedation in patients with paroxysmal and persistent AF undergoing pulmonary vein isolation (PVI) with either PFA or CB from March 2021 until April 2022. The primary study endpoints were the requirements of analgosedation medication (propofol, midazolam and sufenanyl), cardiorespiratory stability measured as decreases in oxygen saturation and systolic blood pressure and analgosedation-associated complications. Secondary endpoints were acute procedural success, procedure time and overall complication rates. 

Results: A total of 100 patients were included {PFA n=50, CB n=50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). The body weight – and procedure time-adjusted requirement of all analgosedation medication was significantly higher in the PFA group compared to CB {Propofol 0.14 ± 0.04 mg/kg/min in PFA versus 0.11 ± 0.04 mg/kg/min in CB (p=0.001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA versus 0.00063 ± 0.0003 mg/kg/min in CB (p=0.002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA versus  0.0008 ± 0.0004 µg/kg/min in CB (p<0.0001)}. Procedural cardiorespiratory stability did not differ between groups (maximum blood pressure decrease PFA 53.4 ± 20.9 mmHg, CB 50.3 ± 18.6 mmHg, P=0.28 and maximum decrease in oxygen saturation: PFA group 4.8 ± 5.3 %, CB group 3.5 ± 2.6 %, P=0.12). Analgosedation-associated complications did not differ between both groups (PFA n=1/50 mild aspiration pneumonia, CB n=0/50, p=0.99).  Acute success (100% n=50/50 in both groups, p>0.99), non-analgosedation associated complications (PFA: n=2/50, 4%, CB: n=1/50, 2%, p=0.99) and procedure times (PFA 75 ± 31, CB 84 ± 32 mins, p=0.18) did not differ significantly between groups.

Conclusions: PFA is associated with higher sedation and especially analgesia requirements compared to CB ablation, however, the safety of analgosedation does not differ significantly to cryoballoon ablation.    

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