Pulsed-field ablation versus single catheter high-power short-duration radiofrequency ablation for atrial fibrillation: procedural characteristics, myocardial injury and midterm outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulsed-field ablation (PFA) has emerged as a novel treatment strategy for patients with atrial fibrillation (AF). A direct comparison to high-power short-duration (HPSD) radiofrequency (RF) ablation using a single catheter is lacking. Aim To compare pulmonary vein isolation (PVI) using PFA versus single catheter HPSD-RF ablation regarding efficiency, safety, myocardial injury, and outcomes. Methods 119 patients underwent PVI and were included (age 65.6 ± 10 years, ejection fraction 0.55 ± 0.11, left atrial size 41 ± 6.6 mm, paroxysmal AF 55%). 56 patients (47%) underwent PFA using a multi-electrode pentaspline PFA catheter with a biphasic waveform and 63 patients (53%) underwent single catheter HPSD-RF ablation without a multipolar mapping catheter. Results Using PFA the median procedure time was significantly shorter compared to the single catheter HPSD-RF group with 58 (IQR 51-70) min versus 83 (IQR 71-99) min (p