Comparison of Two Different Pulsed Field Ablation Systems: The Dual Pulse System Study

Recently, multiple pulsed field ablation (PFA)-system were introduced for catheter ablation (CA) of atrial fibrillation (AF). However, data comparing procedural performance, the extent of low-voltage areas (LVA), and myocardial injury between different PFA-systems in a real-world setting remain scarce.

Consecutive patients undergoing CA for AF were enrolled. PFA was performed using either a Pentaspline catheter-system (PCS) or a loop catheter-system (LCS). The extent of acute antral LVA was assessed using a 3D-electroanatomical mapping system. High-sensitivity cardiac troponin T (hs-cTnT) was measured the day after the procedure to assess myocardial injury.

A total of 120 patients (median age 67 [59-73] years, 29% female) underwent de novo pulmonary vein isolation (PVI). The PCS-group included 90 patients, while the LCS-group included 30 patients. Acute PVI was achieved in all patients (100%). Procedural times were significantly shorter in the PCS compared to the LCS-group, including total procedure duration (57 [48-67] vs 66 [52-83] min, p = 0.016), left atrial dwell time (38 [32-48] vs 54 [38-65] min, p < 0.001), and ablation duration (17 [12-23] vs 24 [20-33] min, p < 0.001). Acute antral LVA and myocardial injury were significantly lower in the PCS compared to the LCS-group (6.6 [5.0-8.9] vs. 19.2 [16.8-25.4] cm², p < 0.001 and hs-cTnT of 1282 [892-1894] vs 1588 [1281-2110] ng/L, p = 0.029.

Significant differences were observed between two commercially available PFA-systems. While PCS was associated with significantly shorter procedural time, LCS resulted in a greater extent of acute antral LVA and myocardial injury levels.