Comparative analysis of pulmonary vein isolation strategies using pulsed field, cryoballoon, and robotic magnetic navigation ablation

Abstract

Aim: Pulsed field ablation (PFA) has emerged as a promising strategy for catheter ablation of atrial fibrillation (AF). This study compared perioperative outcomes of pulmonary vein isolation (PVI) performed using robotic magnetic navigation (RMN), cryoballoon (CRYO) ablation, and PFA.

Methods: This retrospective study included patients with AF who underwent PVI using RMN ablation (RMN group, n = 112), CRYO ablation (CRYO group, n = 189), or PFA (PFA group, n = 50). Procedural characteristics, perioperative complications, and postoperative recovery were analyzed.

Results: Total procedure time was longer in the PFA group than in the CRYO group but shorter than in the RMN group (123.9 ± 14.0 vs. 98.3 ± 14.3 vs. 147.9 ± 19.3 min, P < 0.001). However, left atrial procedure time was shortest in the PFA group (26.6 ± 6.4 vs. 44.7 ± 12.1 vs. 95.1 ± 20.5 min, P < 0.001). Fluoroscopy time was comparable between the PFA and CRYO groups, and significantly shorter in the RMN group (15.2 ± 3.0 vs. 15.0 ± 3.1 vs. 7.4 ± 2.5 min, P < 0.001). Although acute procedural success was comparable across groups, first-pass PVI was achieved more frequently with PFA than with CRYO or RMN {50/50 [100%] vs. 170/189 [89.9%] vs. 100/112 [89.3%], P = 0.030}. The overall incidence of perioperative complications did not differ significantly among the three groups.

Conclusion: PFA demonstrated acute safety and efficacy comparable to those of RMN and CRYO ablation for AF, while offering shorter left atrial procedure time and a higher rate of first-pass isolation.

Keywords

Pulsed field ablation / robotic magnetic navigation / cryoballoon / atrial fibrillation

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