Pulsed electric field and radiofrequency ablation for paroxysmal supraventricular tachycardia: a propensity score-matched comparison (PFA-SVT study).

Pulsed field ablation (PFA) has gained attention in cardiac electrophysiology, but data on its application to paroxysmal supraventricular tachycardia are limited. This study aimed to assess the feasibility and safety of PFA and its combination with radiofrequency ablation for treating paroxysmal supraventricular tachycardia. A prospective, multicenter, single-arm study was conducted across 8 centers in China. Patients with atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, or Wolff-Parkinson-White syndrome underwent ablation using a focal point dual-mode PFA/radiofrequency ablation catheter. PFA was used to achieve acute ablation success, with consolidation using PFA for atrioventricular nodal reentrant tachycardia or near-His accessory pathways and radiofrequency ablation for far-His accessory pathways. Primary and secondary end points were acute ablation success and 180-day follow-up success, respectively. A total of 158 patients (77 with atrioventricular nodal reentrant tachycardia, 63 with atrioventricular reentrant tachycardia, 16 with Wolff-Parkinson-White, and 2 with both atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia) completed the trial. Acute ablation was successful in 157 patients (99.37%). The skin-to-skin procedure time was 89.9±35.5 min. The median number of PFA discharges was 12 (8-19) with a median effective PFA discharge time of 4.6 (3.2-6.4) ms. Five patients (4 with atrioventricular reentrant tachycardia and 1 with Wolff-Parkinson-White syndrome) experienced paroxysmal supraventricular tachycardia recurrence during the 180-day follow-up period. One patient had a transient first-degree atrioventricular block resolving in 12 hours, and one patient had a transient third-degree atrioventricular block resolving in 24 hours. No permanent atrioventricular block or other adverse events occurred during the ablation procedure or 180-day follow-up period. PFA demonstrated the feasibility of the treatment of SVT. Reversible first- and third-degree atrioventricular blocks were observed following ablation in one patient each. The preliminary results indicated the safety and feasibility of a combination of PFA and radiofrequency ablation treatment for atrioventricular accessory pathways although it is impossible to determine the relative contribution of PFA.

Pulsed field ablation (PFA) is a novel, non-thermal technique for atrial fibrillation ablation that is currently under early investigation for paroxysmal supraventricular tachycardia (PSVT). We conducted a meta-analysis to evaluate the efficacy and safety of PFA in this setting. We systematically searched PubMed, Embase, Cochrane Central, and Web of Science for studies on PFA in PSVT, including atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) with concealed or manifest accessory pathways. Outcomes included acute ablation success, success at 1, 3, and 6months, and procedural/postoperative adverse events (AEs). Proportions were pooled using a random-effects model with arcsine transformation to account for extreme values. Analyses were conducted using R (v4.3.2). Five prospective single-arm studies involving 202 patients were included. The pooled acute success rate was 99.98% (95% CI: 99.29-100), with sustained success at 1, 3, and 6months. Procedural and postoperative AE rates were low: 0.92% (95% CI: 0.00-4.88) and 0.06% (95% CI: 0.00-0.87), respectively. Subgroup analysis showed 100% acute success in AVNRT and in AVRT with concealed pathways, with high sustained success at 6months. In AVRT with manifest pathways, acute success was 97.5% (95% CI: 84.74-100), maintained through follow-up. In this systematic review and meta-analysis, PFA demonstrated excellent safety and efficacy for the treatment of PSVT. Randomized controlled trials are warranted to establish the outcomes of PFA in this setting relative to thermal ablation.

Background Women are typically underrepresented in randomized clinical trials, including those focused on atrial fibrillation (AF). The efficacy and safety of pulsed field ablation (PFA) compared to conventional thermal ablation in women have not been well established. Purpose To evaluate the acute efficiency, safety, and long-term outcomes of AF ablation in female-only patients using the Farapulse PFA system versus thermal-based technologies. Methods We conducted a retrospective study on consecutive female patients undergoing AF ablation and enrolled in the ATHENA-CHARISMA registries. Thermal ablation systems (radiofrequency ablation - RF - or cryoablation - Cryo -) were compared to all initial cases approached with the Farapulse PFA system. The ablation approach followed standard clinical practice, with additional lesions performed at the operator’s discretion. Results A total of 1402 female patients (mean age 64±10 years, mean LVEF 59.5±7%, 1058 (75.5%) with paroxysmal AF, 344 (24.5%) with persistent AF) were included: 682 (48.0%) underwent RF ablation, 429 (30.2%) Cryo ablation, and 291 (20.5%) PFA. The PFA group had significantly shorter procedural times (60 [54-80] min) compared to both RF (120 [90-150] min, p<0.001) and Cryo (90 [60-100] min, p<0.001). Fluoroscopy time was lower in the RF group (13.1 [8.4-20] min) compared to both PFA (15 [11-20] min, p=0.0014) and Cryo (15.7 [11-20] min, p=0.0001). Time to PVI was similar between PFA (19 [13-25] min) and RF (18 [11-26] min, p=0.834), but higher in Cryo (22 [16-31] min, p=0.001 vs RF, p<0.001 vs PFA) cases. Overall complication rates were significantly higher with thermal ablation: 1.4% (n=6) with PFA, 4.4% (n=30) with RF (p=0.021 vs PFA), and 5.1% (n=22) with Cryo (p=0.0076 vs PFA). Complete follow-up information was available for 995 (71.0%) patients. During a median follow-up of 406 [349-571] days, 211 (21.1%) patients experienced AF recurrence (median time to recurrence 224 [143-342] days). The Kaplan-Meier estimated freedom from AF was 81.2% with PFA, 80.4% with Cryo, and 77.0% with RF (log-rank p-value: 0.411). Persistent AF patients had a higher AF recurrence rate than paroxysmal AF patients (28.9% vs 18.6%, p=0.0009; HR=1.72, 95% CI: 1.2 to 2.4, p=0.0002). No significant differences were observed among energy sources when separately analyzing paroxysmal and persistent AF patients. Conclusion In female patients undergoing AF ablation, pulsed field ablation resulted in significantly shorter procedural times and a lower rate of complications compared to conventional thermal ablation systems. Follow-up data showed similar rates of AF freedom across all ablation methods.

Background Women are frequently underrepresented in studies investigating atrial fibrillation (AF) ablation. In addition, the comparative efficacy and safety of pulsed-field ablation (PFA) versus conventional thermal ablation techniques in women remain inadequately characterized. Purpose We evaluated the safety and long-term outcomes of de novo paroxysmal AF ablation in female patients using PFA versus thermal-based technologies. Methods Consecutive female patients with paroxysmal AF undergoing de novo pulmonary vein isolation (PVI), enrolled in the ATHENA-CHARISMA registries, were compared by means of a propensity score matching according to thermal ablation systems (radiofrequency [RF] or cryoablation [Cryo]) or the Farapulse PFA system (ratio 1:1:1). Results One-thousand one female patients (mean age 63±10 years, mean LVEF 60.8±6%) were included: 376 (37.6%) underwent Cryo ablation, 342 (34.2%) RF ablation, and 283 (28.3%) PFA. Propensity score matching yielded 684 patients (228 per group). The Kaplan-Meier estimated freedom from AF at 1-year follow-up was 84.9%, with similar rate between PFA and conventional thermal energy (Cryo and RF) and among energy sources considering separately: 86.8% with PFA vs 84% with thermal energy (log-rank p-value: 0.642); 84.6% with Cryo, and 83.3% with RF (overall log-rank p-value: 0.839). At multivariate logistic analysis adjusted for baseline confounders indexed left atrial volume was associated with AF recurrence (HR=1.03, 95%CI: 1.002 to 1.05, p=0.0328). Recurrence free-rate from atrial tachycardia/atrial flutter (AT/AFL) after the 90-day blanking period was 93.9%: 96.1% with PFA vs 92.8% with thermal energy (log-rank p-value: 0.185); 94.3% with Cryo (OR=0.68, 95%CI: 0.28 to 1.62, p=0.385 vs PFA), and 91.2% with RF (OR=0.43, 95%CI: 0.19 to 0.98, p=0.039 vs PFA), overall log-rank p-value=0.182 with a trend in favor of PFA vs RF, log-rank p-value=0.082. Overall complication rate was 3.4% and it was significantly higher after thermal ablation (4.6%) than PFA (0.9%, OR=5.5, 95%, CI: 1.3 to 23.5, p=0.0227). Conclusion In female patients with de novo paroxysmal AF, ablation using the Farapulse PFA system was associated with a lower complication rate compared to thermal ablation modalities. At the one-year follow-up, AF freedom rates were comparable across all ablation techniques. However, AT and AFL recurrences were twice as frequent in the RF ablation group compared to PFA, with a trend toward higher recurrence rates in the Cryo group compared to PFA.

Comparison of Monopolar and Bipolar Pulsed Field vs Radiofrequency Ablation on Coronary Artery Injury in a Swine Model.

ObjectiveTo study the gender and age differences of paroxysmal supraventricular tachycardia.Methods1578 patients with consciously palpitations due to paroxysmal supraventricular tachycardia (PSVT) tachycardia were involved in this study. PSVT was confirmed...

Background and AimsThis trial compared single-procedure efficacy and safety of pulsed field ablation (PFA) vs radiofrequency ablation (RFA) in patients with drug-resistant paroxysmal atrial fibrillation (AF).MethodsBEAT PAROX-AF is a European, multicentre, open-label, randomized, controlled, superiority trial conducted across nine European sites. Eligible patients (aged 18–80 years) with symptomatic, drug-resistant paroxysmal AF were randomized (1:1) to either PFA (pentaspline) or RFA following the CLOSE protocol (contact force sensing catheter and electro-anatomical mapping system). The primary endpoint was the single-procedure success rate after 12 months defined as the absence of ≥30 s atrial arrhythmia recurrence, cardioversion, class I/III antiarrhythmic drug resumption after a 2-month blanking period, or any repeat ablation.ResultsFrom December 2021 to January 2024, 292 patients were randomized and 289 (median age 63.5 years, 58% male) were analysed (PFA n = 145, RFA n = 144). Single-procedure success at 12 months was 112/145 (77.2%) in the PFA group and 111/143 (77.6%) in the RFA group (adjusted difference 0.9%; 95% confidence interval −8.2% to 10.1%; P = .84). Procedure-related serious adverse events occurred in 5 (3.4%) PFA vs 11 (7.6%) RFA patients (difference −3.3% [−8.4%, 1.8%]). No deaths, persistent phrenic palsy nor stroke occurred. In the RFA group, two patients had pulmonary vein stenosis >70% and 12 > 50%, two tamponades, and one oesophageal bleed.ConclusionsThis randomized trial performed in patients with paroxysmal AF did not demonstrate superior efficacy of single-shot PFA vs point-by-point RFA using the CLOSE protocol regarding single-procedure freedom from atrial arrhythmias, despite fewer safety events being observed in this study with PFA.

Background Ablation of non-paroxysmal atrial fibrillation (AF) is challenging and often requires left atrial substrate ablation. While the pentaspline, multi-electrode pulsed-field ablation (PFA) catheter is approved for pulmonary vein isolation (PVI), its role in procedures involving substrate ablation for nonparoxysmal forms of AF remains unknown. Purpose We conducted a retrospective study to assess the safety and long-term outcomes of PFA for non-paroxysmal AF. Methods Procedural and follow-up data were retrospectively collected for all patients undergoing a first-time ablation for non-paroxysmal AF across two centers, between November 2021 and December 2022. Patients undergoing PFA consisting of PVI, isolation of the posterior wall (PWI) and ablation of the mitral isthmus (MI) with the pentaspline multi-electrode PFA catheter, were compared with patients undergoing radiofrequency ablation (RFA) involving PVI, a roof line or PWI, alcohol ablation of the vein of Marshal (VOM) and MI ablation. Patients were matched using propensity scores to minimize potential confounders. The primary endpoint was arrhythmia (AF/atrial flutter/atrial tachycardia) recurrence after a 90-day blanking period. Results The baseline characteristics of the 116 matched patients are detailed in Table 1. PVI was successful in all patients. In the PFA group, PWI was additionally performed in all patients and MI ablation in 83% of cases, resulting in acute success rates of 97% and 96%, respectively. In the RFA group lesions beyond PVI included: a roof line (90%), PWI (10%), VOM alcohol ablation (93%) and MI ablation with ablation in the coronary sinus (CS) if needed (97%). Procedural block across the roof and the MI was achieved in 96% and 95%, respectively and complete PWI in 83% of cases. The PFA group had a shorter total procedure (84.2±22.3 vs 117.3±24.8 min, p<0.001) but a longer fluoroscopy time (23.1±7.2 vs 16.8±6.3 min, p<0.001). The difference in radiation dose, however, was not statistically significant (57.7±74.1 Gy.cm2 in the PFA vs 49.8±53.6 Gy.cm2 in the RFA group, p=0.24). The overall periprocedural complication rates were similar in both groups (8.6% PFA vs 12.1% RFA, p=0.76), with no cardiac tamponades or deaths. Group-specific complications included 1 coronary spasm in the PFA group and 1 CS dissection in the RFA group. During a median follow-up of 447 days (IQR: 364-552), 1 stroke occurred in each group and 1 sudden cardiac death in the RFA group, 13 months post-procedure. Both groups had similar rates of recurrences (32.8% PFA vs 25.9% RFA, p=0.54). Arrhythmia-free survival probability at 16 months was estimated at 67.2% for PFA and 77.6% for RFA by Kaplan-Meier analysis (p=0.16, Figure 1). Conclusions In this propensity-matched cohort of patients with non-paroxysmal AF, PFA and RFA demonstrated similar complication rates and arrhythmia-free survival at follow-up. The procedure duration, however, was significantly shorter with PFA.Figure 1

Background and Aims Pulmonary vein isolation (PVI) is the most effective rhythm control strategy in paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We report the first multicenter experience on PVI via the pentaspline FarapulseTM PFA system versus thermal-based technologies in a propensity score-matched population of paroxysmal AF patients. Methods Propensity score matching was adopted to compare PVI-only ablation outcomes via the FarawaveTM PFA system (Group PFA), cryoballoon ablation (Group CRYO), or focal radiofrequency (Group RF) (PFA:CRYO:RF Ratio=1:2:2). Results Among 1572 (mean age: 62.4±11.3 years; 42.5% females) PAF patients undergoing their first time PVI with either PFA (n=174), CRYO (n=655), or RF (n=743), propensity score matching yielded 174 PFA, 348 CRYO, and 348 RF patients. First-pass isolation was achieved in 98.8% of pulmonary veins (PVs) with PFA, 81.5% with CRYO, and 73.1% with RF (p<0.001). Procedural and dwell times were significantly shorter with PFA. Overall complication rates were 3.4% (n=6) with PFA, 8.6% (n=30) with CRYO, and 5.5% (n=19) with RF (p=0.052). The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 79.3% with PFA, 74.7% with CRYO, and 72.4% with RF (log-rank p-value: 0.24). Among 145 repeat ablation procedures, PV reconnection rate was 19.1% after PFA, 27.5% after CRYO, and 34.8% after RF (p=0.01). Conclusion PFA contributed to significantly shorter procedural times. Follow-up data showed a similar arrhythmia freedom among groups, although a higher rate of PV reconnection was documented in post-CRYO and post-RF redo procedures.RecurrencePVs

BackgroundPulmonary vein isolation (PVI) is the key procedure in managing atrial fibrillation (AF), utilizing different ablation techniques: Pulsed Field Ablation (PFA), Cryoballoon (Cryo), and Radiofrequency (RF). Each modality has distinct cost and procedural efficiency profiles. Although PFA carries higher material costs than Cryo and RF, it significantly reduces procedure duration, potentially offsetting expenses through reduced staffing costs for physicians and nurses in the electrophysiology (EP) lab.PurposeThis study evaluates the cost-effectiveness of PFA compared to Cryo and RF, particularly in light of potential savings from reduced staff time.MethodsWe retrospectively analyzed AF patients undergoing PVI between January 2024 and October 2024 in our center. The primary endpoint was total EP lab time, with secondary analysis focusing on adjusted costs accounting for procedural duration. Specifically, the study examined cost savings related to reduced physician and nursing time in the EP lab and the financial impact relative to RF.ResultsOf 467 patients (63% male, 45% PAF, 68±11 years) undergoing PVI, 133 were treated with PFA, 40 with Cryo, and 294 with RF. PFA patients spent an average of 101±22 min in the EP lab, compared to 156±39 min for Cryo and 195±61 min for RF (p<0.001). Accordingly, procedure duration was lower in PFA (41±12 min) than for Cryo (75±23 min) and RF (119±39 min) [p<0.001]. After accounting for reduced procedural time and the associated savings in physician and nursing costs, the per-procedure cost for PFA remained €721 higher than RF, while Cryo exceeded RF by €474 (p<0.001).ConclusionIn our analysis the shorter lab time of PFA and Cryo did not result in an alignment to cost effectiveness to RF PVI but partly compensated for the higher costs for disposables. Though PFA incurs higher procedural costs compared to RF and Cryo, its shorter EP lab time offers cost-saving potential through reduced physician and nurse time, enhancing operational efficiency. Increased procedural capacity with PFA may also drive additional DRG revenue, which should be investigated in further large-scaled studies.

Aim: This study aims to evaluate the outcomes of patients who underwent radiofrequency ablation (RFA) for paroxysmal supraventricular tachycardia (PSVT) at the Cardiology Clinic of Celal Bayar University Faculty of Medicine. Methods: A total of 156 patients admitted to the clinic for PSVT were retrospectively included in the study. All patients underwent RFA. Results: Among the patients who underwent RFA, 72% had atrioventricular nodal reentrant tachycardia (AVNRT), 23% had atrioventricular reentrant tachycardia (AVRT), and 5% had atrial tachycardia (AT). Atypical AVNRT was detected in 2.7% of patients (n = 3), and antidromic AVRT in 5.5% (n = 2). Females accounted for 65.3% of the cohort, while males made up 34.7%. The mean age of the study population was 46.2 ± 15.2 years, with the AVRT group being significantly younger (mean age 38.3 ± 13.6 years, p &lt; 0.05). Comorbidities such as coronary artery disease, hypertension, and diabetes mellitus were more prevalent in the AVNRT group than in the AVRT group. Additionally, total cholesterol, LDL cholesterol, neutrophil/lymphocyte ratio, and CRP levels were significantly higher in the AVNRT group (p &lt; 0.05). The most common accessory pathway in the AVRT group was the left lateral pathway (44.4%). Recurrence was observed in two AVNRT patients and one AVRT patient, all of whom underwent successful repeat procedures. Hematoma at the intervention site occurred in four AVNRT patients and was managed conservatively. Permanent pacemaker implantation was required in one patient from each of the AVNRT and AVRT groups. Coronary artery injury necessitating stenting occurred in one AVRT patient. Conclusion: The treatment outcomes for PSVT patients in our clinic were comparable to those reported in the literature. Our early success rates were higher; however, the limited number of patients included in the study presents a limitation. Technological advancements in 3D mapping systems are expected to further enhance success rates and reduce complications. Keywords: Paroxysmal supraventricular tachycardia, radiofrequency ablation, cardiac electrophysiology, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, atrial tachycardia.

Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We describe a multicentre experience on pulmonary vein isolation (PVI) via the pentaspline Farapulse™ PFA system vs. thermal-based technologies in a propensity score-matched population of paroxysmal atrial fibrillation (PAF) patients. Propensity score matching was adopted to compare PVI-only ablation outcomes via the Farawave™ system (Group PFA), cryoballoon (Group CRYO), or focal radiofrequency (Group RF) (PFA:CRYO:RF ratio = 1:2:2). Among 1572 (mean age: 62.4 ± 11.3 years; 42.5% females) PAF patients undergoing first time PVI with either PFA (n = 174), CRYO (n = 655), or RF (n = 743), propensity score matching yielded 174 PFA, 348 CRYO, and 348 RF patients. First-pass isolation was achieved in 98.8% of pulmonary veins (PVs) with PFA, 81.5% with CRYO, and 73.1% with RF (P < 0.001). Procedural and dwell times were significantly shorter with PFA, whereas the availability of a 3D mapping system led to a significant reduction in X-ray exposure with RF. Overall complication rates were 3.4% (n = 6) with PFA, 8.6% (n = 30) with CRYO, and 5.5% (n = 19) with RF (P = 0.052). The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 79.3% with PFA, 74.7% with CRYO, and 72.4% with RF (log-rank P-value: 0.24). Among 145 repeat ablation procedures, PV reconnection rate was 19.1% after PFA, 27.5% after CRYO, and 34.8% after RF (P = 0.01). Pulsed field ablation contributed to significantly shorter procedural times. Follow-up data showed a similar arrhythmia freedom, although a higher rate of PV reconnection was documented in post-CRYO and post-RF redo procedures.

Introduction Atrial fibrillation (AF) is the most common sustained arrhythmia, and pulmonary vein isolation (PVI) remains the cornerstone of treatment. Thermal-based ablation techniques, such as cryoballoon ablation (CBA) and radiofrequency ablation (RFA), are widely used for PVI but show notable recurrence rates, particularly in obese patients. One possible reason for these suboptimal outcomes is the reduced efficacy of thermal energy in tissues with significant epicardial fat, which can impede effective lesion formation and insulation of targeted areas. Recently, pulsed field ablation (PFA), a non-thermal modality, has shown promise for AF treatment, providing effective isolation with a favorable safety profile. This study investigates the clinical and safety outcomes of PFA compared to CBA in obese patients with AF. Methods This retrospective propensity-matched study included symptomatic paroxysmal and persistent AF patients with a body mass index (BMI) &amp;gt;30 kg/m² who underwent PFA or CBA at a single institution between January 2020 and September 2024. Procedural workflows for both PFA and CBA were standardized, focusing solely on PV isolation. Post-procedural follow-up involved 72-hour Holter monitoring at 3, 6, and 12 months. Key outcomes assessed were procedural efficiency, recurrence rates, and complications. Results Pre-matching, no significant differences in 1-year recurrence rates were observed between the two methods. However, post-matching revealed lower recurrence rates in the PFA group (25%) compared to the CBA group (42.9%, p=0.02). PFA was associated with significantly shorter left atrial (LA) time (33.8 min. vs. 49.7 min., p&amp;lt;0.01) and procedural time (46.8 min. vs. 69.3 min., p&amp;lt;0.01) than CBA, although fluoroscopy time showed no significant difference. Safety outcomes were similar across both groups. Conclusion PFA offers a viable alternative to CBA in obese patients, with superior recurrence outcomes and shorter procedural durations post-matching in this single-center cohort. Both methods demonstrate comparable safety profiles. Given the procedural and clinical benefits observed, PFA may serve as a preferred approach for AF management in this high-risk population. Future randomized trials are warranted to validate these findings and optimize treatment protocols for obese AF patients.

Comparison of 30-day readmission and same-day discharge rates in patients undergoing pulsed field vs radiofrequency ablation for atrial fibrillation: A multicenter analysis.

PO-01-005 GANGLIONATED PLEXI MEDIATED BRADYCARDIA RESPONSES: A PRE-CLINICAL STUDY OF DIFFERENCES BETWEEN PULSED FIELD AND RADIOFREQUENCY ABLATION IN THE LEFT ATRIUM