Pulsed Field Versus Radiofrequency Ablation For Repeat Ablation of Atrial Fibrillation: Evaluation of Outcomes

Background Pulsed-field ablation (PFA) has recently been approved in the USA as a new method for treating atrial fibrillation (AF). PFA provides a promising new approach in the treatment of atrial fibrillation (AF), which historically has a high recurrence rate post-ablation. Of significance, PFA has shown promising data in terms of safety and procedural efficiency to radiofrequency ablation (RFA). Objective The purpose of this study was to compare the procedural and health outcomes in patients with recurrent AF undergoing ablation using PFA or RFA. Methods Consecutive patients with a history of previous radiofrequency ablation and recurrent AF undergoing redo ablation with PFA or RFA were included. Patients were seen for follow-up in the clinic ranging from 4 months to a year and we reported ablation strategy and arrhythmia type. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period. Results A total of 242 patients with recurrent AF underwent redo ablation using PFA (n = 54, 22.5%) or RFA (n = 188, 77.5%). The PFA cohort was younger on average (66 vs. 70 years) with a lower mean CHA2DS2-VASc score (2.2 vs. 3.06, p=0.001) compared to the RFA cohort. PFA procedures were shorter (162{+/-}53 vs 206{+/-}60 minutes, p<0.001) but required more fluoroscopy (13.9{+/-}8.9 vs 8.7{+/-}6.3 minutes, p<0.001). Among patients seen on follow-up, recurrence occurred in 28% of PFA versus 55% of RFA patients, with longer arrhythmia-free survival after PFA (log-rank p=0.03). PFA remained associated with lower recurrence after multivariable adjustment (HR 0.4, 95% CI 0.2?0.9, p=0.04). Adverse events, predominantly vascular access?related, were similar. Conclusion Among patients with recurrent atrial arrhythmias after prior RFA, repeat PFA was associated with shorter procedures, greater fluoroscopy use, and lower arrhythmia recurrence, with comparable safety.