Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation
Background: Current thermal energy sources such as cryoballoon (Cryo) ablation technology are associated with high rates of reconnected pulmonary veins (PV), especially in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) may represent a more suitable ablation modality f...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725000879 |
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| author | Corinne Isenegger Rebecca Arnet Fabian Jordan Sven Knecht Philipp Krisai Gian Völlmin Jonas Brügger David Spreen Nicolas Schaerli Behnam Subin Beat Schär Nicola Formenti Felix Mahfoud Christian Sticherling Michael Kühne Patrick Badertscher |
| author_facet | Corinne Isenegger Rebecca Arnet Fabian Jordan Sven Knecht Philipp Krisai Gian Völlmin Jonas Brügger David Spreen Nicolas Schaerli Behnam Subin Beat Schär Nicola Formenti Felix Mahfoud Christian Sticherling Michael Kühne Patrick Badertscher |
| author_sort | Corinne Isenegger |
| collection | DOAJ |
| description | Background: Current thermal energy sources such as cryoballoon (Cryo) ablation technology are associated with high rates of reconnected pulmonary veins (PV), especially in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) may represent a more suitable ablation modality for this patient population. This study aims to compare the efficacy, and safety of PFA and Cryo in patients undergoing a PVI only approach for persistent AF. Method: Patients with persistent AF who underwent PVI at a tertiary referral center using either PFA or Cryo were consecutively enrolled. Results: A total of 220 patients (median age 66 [60–72] years, 24 % female) were included out of which 113 patients (51 %) underwent PFA and 107 patients (49 %) Cryoablation. Median procedure duration, LA dwell time and fluoroscopy time were shorter in the PFA group: 49 [39–61] min vs 60 [49–75] min (p < 0.001), 34 [25–43] min vs 37 [31––53] min (p < 0.001), and 9 [8–13] min vs 11 [8–16] min (p = 0.008). During a median follow-up of 365 days, recurrence-free survival was 72 % in the PFA group and 60 % in the Cryo group (pLog-rank = 0.079). The change in AF type from persistent AF to paroxysmal AF was more frequently observed after PFA than after Cryo (68 % vs 37 %; p = 0.011). Conclusion: In patients with persistent AF undergoing a PVI only approach, PFA was associated with shorter procedural times and similar efficacy, with a higher frequency of regression from persistent to paroxysmal AF. Future studies are needed to evaluate the role of ablation strategies beyond PVI when using PFA. |
| format | Article |
| id | doaj-art-ed6103cbd5f448728fb7fc402fa94422 |
| institution | Kabale University |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-ed6103cbd5f448728fb7fc402fa944222025-08-20T04:02:13ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-08-015910168410.1016/j.ijcha.2025.101684Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillationCorinne Isenegger0Rebecca Arnet1Fabian Jordan2Sven Knecht3Philipp Krisai4Gian Völlmin5Jonas Brügger6David Spreen7Nicolas Schaerli8Behnam Subin9Beat Schär10Nicola Formenti11Felix Mahfoud12Christian Sticherling13Michael Kühne14Patrick Badertscher15Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, SwitzerlandDepartment of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland; Corresponding author at: University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.Background: Current thermal energy sources such as cryoballoon (Cryo) ablation technology are associated with high rates of reconnected pulmonary veins (PV), especially in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) may represent a more suitable ablation modality for this patient population. This study aims to compare the efficacy, and safety of PFA and Cryo in patients undergoing a PVI only approach for persistent AF. Method: Patients with persistent AF who underwent PVI at a tertiary referral center using either PFA or Cryo were consecutively enrolled. Results: A total of 220 patients (median age 66 [60–72] years, 24 % female) were included out of which 113 patients (51 %) underwent PFA and 107 patients (49 %) Cryoablation. Median procedure duration, LA dwell time and fluoroscopy time were shorter in the PFA group: 49 [39–61] min vs 60 [49–75] min (p < 0.001), 34 [25–43] min vs 37 [31––53] min (p < 0.001), and 9 [8–13] min vs 11 [8–16] min (p = 0.008). During a median follow-up of 365 days, recurrence-free survival was 72 % in the PFA group and 60 % in the Cryo group (pLog-rank = 0.079). The change in AF type from persistent AF to paroxysmal AF was more frequently observed after PFA than after Cryo (68 % vs 37 %; p = 0.011). Conclusion: In patients with persistent AF undergoing a PVI only approach, PFA was associated with shorter procedural times and similar efficacy, with a higher frequency of regression from persistent to paroxysmal AF. Future studies are needed to evaluate the role of ablation strategies beyond PVI when using PFA.http://www.sciencedirect.com/science/article/pii/S2352906725000879Atrial fibrillationPulsed field ablationCryoballoon ablationPulmonary vein isolation |
| spellingShingle | Corinne Isenegger Rebecca Arnet Fabian Jordan Sven Knecht Philipp Krisai Gian Völlmin Jonas Brügger David Spreen Nicolas Schaerli Behnam Subin Beat Schär Nicola Formenti Felix Mahfoud Christian Sticherling Michael Kühne Patrick Badertscher Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation International Journal of Cardiology: Heart & Vasculature Atrial fibrillation Pulsed field ablation Cryoballoon ablation Pulmonary vein isolation |
| title | Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation |
| title_full | Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation |
| title_fullStr | Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation |
| title_full_unstemmed | Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation |
| title_short | Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation |
| title_sort | pulsed field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation |
| topic | Atrial fibrillation Pulsed field ablation Cryoballoon ablation Pulmonary vein isolation |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725000879 |
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