A single-center single-shot devices experience for pulmonary vein isolation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) is the gold standard for treatment of atrial fibrillation (AF). Single-shot devices have been introduced to provide a faster and more simplified approach to achieve PVI. We sought to evaluate our single-center experience with different single-shot devices for the treatment of AF. Methods Evaluation included 25 propensity score matched patients (age, gender, AF-type, CHADSVAsc score) for each single-shot device (i) Arctic Front 4th generation cryoballon (CB G4), (ii) PolarX cryoballoon, (iii) X3 laserballoon, (iv) single-access pulsed field ablation (PFA) as part of our prospective observational AF registry who underwent first-time ablation for symptomatic AF. The first 20 cases (learning curve) with each technology and those with pre/post mapping were rejected from the analysis. Procedures were performed by the institute´s standard operational procedures. Procedural characteristics and safety data were compared. Results A total of 100 symptomatic AF patients (66±8 years, 57% paroxysmal AF, 42% female, CHADSVasc Score 1.2±1) underwent first-time PVI with a single-shot device. Acute PVI rates were 96-100%. Treatment with either cryoballoon systems revealed similar procedure characteristics between vendors. Balloon-based procedures were associated with longer procedure times between 54-57 min. Using a single-access PFA approach, procedure (26 [25-30] min) and fluoroscopy times (5 [IQR 5;7] min) were significantly reduced (p<0.001). Significantly smaller amounts of contrast medium were needed in laser and PFA procedures in comparison to both cryoballoons (p<0.001). Adverse event rates did not differ between technologies. Details are given in Table 1-3 and Figure 1. Conclusion In our prospective ablation registry, first-time AF ablation using single-access PFA outperformed other common single-shot devices. Procedure and fluoroscopy times were significantly reduced by approximately 50% in comparison to balloon-based technologies (p<0.001). A comparable safety profile was found between PFA, cryo- and laser energy.