Comparative evaluation of 2 pulsed field ablation systems for atrial fibrillation: insights from real-world clinical implementation and short-term outcomes

Abstract

Pulsed field ablation (PFA) is a safe and effective technology for catheter ablation of atrial fibrillation (AF). Multiple PFA-platforms for AF ablation have been developed. However, evidence comparing the real-world implementation and performance of different PFA systems is still limited. This study compares procedural and acute outcome parameters during implementation of the PFA system employing a pentaspline PFA catheter (FARAPULSE, Boston Scientific, Marlborough, MA) and a platform using a circular PFA-catheter (PulseSelect, Medtronic, Minneapolis, MN). The first consecutive 40 patients treated with each PFA system were included. Baseline characteristics, procedural parameters, and short-term outcome regarding periprocedural safety and efficacy were evaluated. The majority of patients showed paroxysmal AF, nearly one-third of patients in both groups suffered from persistent AF. Overall procedural complication rates were not different among subgroups (circular catheter: 12.5%; pentaspline catheter: 7.5%, P = .71), mainly minor (circular catheter: 10.0%; pentaspline catheter: 7.5%, P =1.00). There was no significant difference in median procedure duration (circular catheter: 42.0 minutes; pentaspline catheter: 43.0 minutes, P = .292), left atrial (LA) dwell time (circular catheter: 29.0 minutes; pentaspline catheter: 31.0 minutes, P = .623), and fluoroscopy duration (circular catheter: 13.2 min; pentaspline catheter: 11.9 minutes, P = .132). With the pentaspline PFA catheter, no learning curve was observed regarding procedural parameters over the course of 40 procedures. With the circular PFA catheter, there was a statistically significant decrease in LA dwell time and fluoroscopy duration comparing the first and last 10 procedures. Both PFA systems could be safely and rapidly implemented into clinical practice of an experienced center. Large-scale clinical trials are needed to compare long-term outcome between different PFA systems currently introduced into clinical practice.