Lesion area, ablation time, fluoroscopic time, and short-term outcomes among 3 pulsed field ablation systems

Three pulsed field ablation (PFA) systems are approved in Japan: a pentaspline catheter (FARAPULSE [FP]) and 2 loop circular catheters (VARIPULSE [VP] and PulseSelect [PS]). However, the differences in the lesion characteristics, procedural parameters, complications, and short-term outcomes remain unclear.

This study aimed to compare the PFA-related features among the FP, VP, and PS systems.

Overall, 75 patients with atrial fibrillation (paroxysmal: 54; persistent: 21) underwent PFA using FP (n = 25), VP (n = 25), or PS (n = 25). Post-ablation, low-voltage areas (<0.1 mV) in the pulmonary vein (PV) antrum were quantified as lesion areas.

The PV isolation time was shorter with FP (20 ± 7 min) than VP (32 ± 12 min, P < .0003) and PS (33 ± 7 min, P < .0003). The fluoroscopy time was lower with VP (0 [0-0] min) than FP (22 [14-27] min, P < .0003) or PS (16 [11-28] min, P < .0003). The lesion distribution varied: (1) FP created larger lesions for the posterior right inferior PV, (2) VP created broader lesions for the posterior left inferior PV (LIPV) and smaller for the posterior right superior PV (RSPV) and right inferior PV, and (3) PS created greater lesions for the posterior right superior PV and smaller for the anterior left superior PV. The haptoglobin decline was smallest with PS (8 [0-17] mg/dL), compared to FP (35 [24-46], P < .0003) and VP (36 [11-52], P < .0003).

Despite similar total lesion areas, the PFA systems showed distinct lesion patterns. FP had the shortest procedure time, VP the lowest radiation exposure, and PS the least haptoglobin reduction, potentially indicating less hemolysis.