Pulsed‐field versus cryoballoon ablation for atrial fibrillation—Impact of energy source on sedation and analgesia requirement

Introduction Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single‐shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single‐shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB. Methods Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective CB‐PVI cohort of the same timeframe. Study endpoints were the requirements of analgesics, cardiorespiratory stability, and sedation‐associated complications. Results A total of 100 PVI patients were included (PFA n = 50, CB n = 50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). Requirement of propofol, midazolam, and sufentanyl was significantly higher in the PFA group compared to CB [propofol 0.14 ± 0.04 mg/kg/min in PFA vs. 0.11 ± 0.04 mg/kg/min in CB (p = .001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA vs. 0.0006295 ± 0.0003 mg/kg/min in CB (p = .002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA vs. 0.0008 ± 0.0004 µg/kg/min in CB (p .99). Nonsedation‐associated complications (PFA: n = 2/50, 4%, CB: n = 1/50, 2%, p > .99) and procedure times (PFA 75 ± 31, CB 84 ± 32 min, p = .18) did not differ between groups. Conclusions PFA is associated with higher sedation and especially analgesia requirements. However, the safety of deep sedation does not differ to CB ablation. Condensed This study sought to compare the requirements and safety of deep sedation in patients undergoing pulmonary vein isolation (PVI) with either a pentaspline pulsed field ablation (PFA) catheter, a novel energy modality, or cryoballoon (CB) ablation, an established energy source. In 100 patients undergoing PVI (PFA: n = 50, CB: n = 50), the requirement of analgosedation was significantly higher in the PFA group compared to CB, especially with regard to analgesics. There was no difference in sedation‐associated and nonsedation‐associated complications between groups.