1
|
Rattka M, Mavrakis E, Vlachopoulou D, Rudolph I, Kohn C, Bohnen J, Yahsaly L, Siebermair J, Wakili R, Jungen C, Rassaf T, Mathew S. Pulsed field ablation and cryoballoon ablation for pulmonary vein isolation: insights on efficacy, safety and cardiac function. J Interv Card Electrophysiol 2024; 67:1191-1198. [PMID: 38273159 PMCID: PMC11289198 DOI: 10.1007/s10840-024-01748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) has become the cornerstone treatment of atrial fibrillation (AF). While in cryoablation cell damage is caused by thermal effects, lately, pulsed field ablation (PFA) has been established as a novel non-thermal tissue-specific ablation modality for PVI. However, data comparing outcomes of patients undergoing either PFA or cryoballoon ablation (CBA) for primary PVI are sparse. METHODS Consecutive patients with AF undergoing PVI by either CBA or PFA were included in the analysis. The primary outcome was the time to AF/AT recurrence. For secondary outcomes, clinical and periprocedural parameters were compared. RESULTS In total, outcomes of 141 AF patients treated by PFA (94 patients) or CBA (47 patients) were compared. After 365 days, 70% of patients in the PFA group and 61% of patients in the CBA group were free from AF/AT (HR 1.35, 95% CI 0.60-3.00; p = 0.470). No deaths occurred. While symptoms alleviated in both groups, only after PFA, we observed significant improvement of left atrial volume index (PFA group baseline: 40 [31;62] ml/m2, PFA group follow-up: 35 [29;49] ml/m2; p = 0.015), NT-pro BNP levels (PFA group baseline: 1106 ± 2479 pg/ml, PFA group follow-up: 1033 ± 1742 pg/ml; p = 0.048), and left ventricular ejection fraction (LVEF) (PFA group baseline: 55 [48;60] %, PFA group follow-up: 58 [54;63] %; p = 0.006). PVI by PFA was the only independent predictor of LVEF improvement. CONCLUSION In our study, we show that CBA and PFA for PVI are of similar efficacy when it comes to AF recurrence. However, our findings suggest that PFA rather than CBA might induce left atrial reverse remodeling thereby contributing to left ventricular systolic function.
Collapse
Affiliation(s)
- Manuel Rattka
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Evangelos Mavrakis
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Dimitra Vlachopoulou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Isabel Rudolph
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Christina Kohn
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Jan Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Loubna Yahsaly
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Krankenhaus Goettlicher Heiland, Vienna, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Department of Cardiology and Vascular Medicine, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Christiane Jungen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Shibu Mathew
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
| |
Collapse
|
2
|
de Campos MCAV, Moraes VRY, Daher RF, Micheleto JPC, de Campos LAV, Barros GFA, de Oliveira HM, Barros LP, Menezes ADS. Pulsed-field ablation versus thermal ablation for atrial fibrillation: A meta-analysis. Heart Rhythm O2 2024; 5:385-395. [PMID: 38984363 PMCID: PMC11228281 DOI: 10.1016/j.hroo.2024.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Background Pulsed-field ablation (PFA) is an alternative to thermal ablation (TA) in patients with atrial fibrillation (AF) receiving catheter-based therapy for pulmonary vein isolation (PVI). However, its efficacy and safety have yet to be fully elucidated. Objective The purpose of this study was to compare the acute and long-term efficacies and safety of PFA and TA. Methods We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials comparing PFA and TA in patients with AF undergoing their first PVI ablation. The TA group was divided into cryoballoon (CB) and radiofrequency subgroups. AF patients were divided into paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF) subgroups for further analysis. Results Eighteen studies involving 4998 patients (35.2% PFA) were included. Overall, PFA was associated with a shorter procedure time (mean difference [MD] -21.68; 95% confidence interval [CI] -32.81 to -10.54) but longer fluoroscopy time (MD 4.53; 95% CI 2.18-6.88) than TA. Regarding safety, lower (peri-)esophageal injury rates (odds ratio [OR] 0.17; 95% CI 0.06-0.46) and higher tamponade rates (OR 2.98; 95% CI 1.27-7.00) were observed after PFA. In efficacy assessment, PFA was associated with a better first-pass isolation rate (OR 6.82; 95% CI 1.37-34.01) and a lower treatment failure rate (OR 0.83; 95% CI 0.70-0.98). Subgroup analysis showed no differences in PersAF and PAF. CB was related to higher (peri)esophageal injury, and lower PVI acute success and procedural time. Conclusion Compared to TA, PFA showed better results with regard to acute and long-term efficacy but significant differences in safety, with lower (peri)esophageal injury rates but higher tamponade rates in procedural data.
Collapse
Affiliation(s)
| | | | - Rafael Ferreira Daher
- Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | | | - Luiza Azzi Vaz de Campos
- Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | | | - Heitor Martins de Oliveira
- Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Lorrany Pereira Barros
- Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Antonio da Silva Menezes
- Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
- Internal Medicine Department, Medical Faculty, Federal University of Goiás, Goiânia, Goiás, Brazil
| |
Collapse
|
3
|
Zhang H, Zhang H, Lu H, Mao Y, Chen J. Meta-analysis of pulsed-field ablation versus cryoablation for atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:603-613. [PMID: 38525525 DOI: 10.1111/pace.14971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE The available data on the treatment strategy of pulsed field ablation (PFA) for patients with atrial fibrillation (AF) is limited. This study aims to provide a comparative analysis of the efficacy, safety, and procedural efficiency between PFA and cryoballoon ablation (CBA) for AF. METHODS We conducted a comprehensive search of the EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov databases to identify trials comparing PFA with CBA for AF from their inception until December 2023. The odds ratio (OR) and mean difference (MD), along with a 95% confidence interval (CI), were utilized as measures of treatment effect. RESULTS The analysis included 15 eligible trials with a total enrollment of 1880 patients. No significant differences were found in recurrent atrial arrhythmia (OR 0.83, 95% CI 0.64, 1.07) or periprocedural complications (OR 0.78, 95% CI 0.46, 1.30) between the two ablation techniques examined in this study. However, the PFA technique demonstrated a significantly shorter procedure time (MD -7.17, 95% CI -13.60, -0.73), but a longer fluoroscopy time (MD 2.53, 95% CI 0.87, 4.19). Similarly, PFA was found to be significantly associated with a decreased incidence of phrenic nerve palsy (OR 0.20, 95% CI 0.07, 0.59), but an increased incidence of cardiac tamponade (OR 4.07, 95% CI 1.15, 14.39). Moreover, there was a significantly higher release of troponin with PFA compared to CBA (MD 470.28, 95% CI 18.89, 921.67), while the increase in S100 protein and heart rate was significantly lower with PFA than with CBA (MD -64.41, 95% CI -105.46, -17.36), (MD -8.76, 95% CI -15.12, -2.40). CONCLUSION The utilization of PFA provides a safer, time-saving, and tissue-specific procedure compared to CBA, while maintaining comparable success rates. This has the potential to enhance procedural efficiency and optimize resource utilization in clinical practice. These findings underscore the feasibility and promise of PFA as an alternative technique for PVI in patients with AF.
Collapse
Affiliation(s)
- Hehua Zhang
- Department of Anesthesiology, Ninghua County General Hospital, Sanming, China
| | - Hua Zhang
- Department of Cardiovascular Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Heng Lu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yinjun Mao
- Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianxing Chen
- Department of Anesthesiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| |
Collapse
|
4
|
Rudolph I, Mastella G, Bernlochner I, Steger A, von Olshausen G, Hahn F, Wakili R, Laugwitz KL, Martens E, Rattka M. Efficacy and safety of pulsed field ablation compared to cryoballoon ablation in the treatment of atrial fibrillation: a meta-analysis. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae044. [PMID: 38933428 PMCID: PMC11200106 DOI: 10.1093/ehjopen/oeae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/04/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024]
Abstract
Aims Pulmonary vein isolation (PVI) represents the gold standard in the treatment of atrial fibrillation (AF) and the use of single-shot techniques, such as cryoballoon ablation (CBA) and pulsed field ablation (PFA) using a pentaspline catheter, has gained prominence. Recent studies hypothesize that PFA might be superior to CBA, although procedural efficacy and safety data are inconsistent. A meta-analysis was conducted to compare both energy sources for the treatment of AF. Methods and results A structured systematic database search and meta-analysis were performed on studies investigating outcomes, periprocedural complications, and/or procedural parameters of AF patients treated by either CBA or PFA. Eleven studies reporting data from 3805 patients were included. Pulmonary vein isolation by PFA was associated with a significantly lower recurrence of atrial fibrillation/atrial tachycardia [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.54-0.98, I2 = 20%] and fewer periprocedural complications (OR = 0.62, 95% CI = 0.40-0.96, I2 = 6%) compared to CBA. The lower complication rate following PFA was mainly driven by fewer phrenic nerve injuries (OR = 0.19, 95% CI = 0.08-0.43, I2 = 0%). However, there were more cases of cardiac tamponades after PFA (OR = 2.56, 95% CI = 1.01-6.49, I2 = 0%). Additionally, using PFA for PVI was associated with shorter total procedure times [mean difference (MD) = -9.68, 95% CI = -14.92 to -4.43 min, I2 = 92%] and lower radiation exposure (MD = -148.07, 95% CI = -276.50 to -19.64 µGy·mI2 = 7%). Conclusion Our results suggest that PFA for PVI, compared to CBA, enables shorter procedure times with lower arrhythmia recurrence and a reduced risk of periprocedural complications. Randomized controlled trials need to confirm our findings.
Collapse
Affiliation(s)
- Isabel Rudolph
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Giulio Mastella
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Isabell Bernlochner
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Alexander Steger
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Gesa von Olshausen
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Franziska Hahn
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Reza Wakili
- Department of Medicine and Cardiology, Goethe University, Frankfurt, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Karl-Ludwig Laugwitz
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Eimo Martens
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
- European Reference Network Guard Heart, European Union
| | - Manuel Rattka
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| |
Collapse
|