SPC365

Pulsed Field Ablation: A New Standard for Single-shot Atrial Fibrillation Ablation

Session: SESSÃO DE COMUNICAÇÕES ORAIS 12 - AVANÇOS EM ABLAÇÃO: TÉCNICAS, FERRAMENTAS E RESULTADOS
Speaker: Ana Lobato De Faria Abrantes

Congress: CPC 2025
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Session Type: Comunicações Orais
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Authors: Ana Lobato de Faria Abrantes; Miguel Azaredo Raposo; Catarina Gregório; João Cravo; Ana Bernardes; Joana Brito; Nelson Cunha; Afonso Nunes Ferreira; Gustavo Lima da Silva; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa

<p><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"> Pulsed field ablation (PFA) induces cell death through electroporation, offering a potentially safer and more effective method for atrial fibrillation (AF) ablation.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"> To compare the acute and long-term efficacy, safety, and procedural duration of PFA and cryoablation (CA) for pulmonary vein isolation (PVI).</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"> This single-center, prospective study included AF patients (pts) undergoing PVI with either PFA (Farapulse system) or CA from January 2023 to November 2024. Ablation included cavotricuspid isthmus (CTI) ablation for pts with concomitant atrial flutter (AFL). Groups were matched using propensity scores based on AF type and CHA</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">DS</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">-VASc scores. Acute success was defined as complete PVI. Safety was assessed by major/minor complications, and procedural duration was defined as the total skin-to-skin time. Kaplan-Meier survival analysis was used to compare the long-term efficacy, defined as freedom from AF, or atrial tachycardia post a 90-day blanking period.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"> Of 315 pts undergoing PVI, 204 were matched (1:1): 64% male, 66&plusmn;13 years, CHA</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">DS</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">-VASc 2.4&plusmn;1.3, with paroxysmal (69%), short-duration (14%), or long-standing persistent AF (15%). Acute success (PFA: 99% vs. CA: 96%), major (PFA: 2% vs. CA: 1%) and minor complications (PFA: 1% vs. 5%) showed no significant differences (Table 1). Procedure time, which included CTI ablation in 20%, was shorter with PFA (55&plusmn;25 vs. 84&plusmn;28 min, p&lt;0.001) with similar fluoroscopy times (Table 1). One PFA pt died from femoral hemorrhage within 30 days. Over a 469&plusmn;19 days median follow-up, long-term efficacy showed no significant difference (PFA: 72% vs. CA: 66%) (Table 2).&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"> PFA is an innovative technology for rapid PVI with comparable safety and efficacy, establishing it as the preferred single-shot AF ablation technique.</span></span></span></p>

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