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Long-Term Outcome of Radiofrequency Versus Pulsed-Field Ablation in Atrial Fibrillation Patients Aged More Than 60
Pamela Horton Embrey1, Sanghamitra Mohanty2, Prem Geeta Torlapati2
1Division of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Background:
We evaluated the impact of pulsed-field (PFA) vs. radiofrequency ablation (RFA) on long-term ablation outcome in AF patients and whether the benefit was extended to all age groups, in a real-world population.
Methods:
Consecutive AF patients undergoing their first ablation procedure were classified based on their age at baseline; group 1: > 60 years and group 2: ≤ 60 years. Each group were then subclassified based on the energy modality used; group 1A or 2A: received RFA, and group 1B or 2B: underwent PFA. All patients received isolation of PVs and left atrial posterior wall.
Results:
A total of 1386 patients were included in group 1 (Gr 1A: 954; Gr 1B: 432) and 414 subjects in group 2 (Gr 2A: 284; Gr 2B: 130). Patients in group 1 were sicker with more comorbidities. At the end of 1-year follow-up, significantly higher recurrence rate was reported in group 1 patients receiving RFA compared to PFA (249 (26.1%) vs. 45 (10.4%), p < 0.001), whereas the recurrence rate was comparable between the two subgroups in group 2 (RFA: 69 (24.3%) vs. PFA: 22 (17%), p = 0.095). Mean time to recurrence was significantly longer in the Gr. 2B (PFA) population compared to RFA (7.21 ± 1.87 vs. 7.75 ± 2.03 months, p = 0.008) and comparable in Gr. 1 (RFA: 7.98 ± 1.29 vs. PFA: 8.12 ± 1.80 months, p = 0.531). After controlling for the variables in the multivariate model, PFA was associated with lower risk (OR = 0.378, 95% CI 0.265, 0.539; p-value < 0.001) and Persistent AF with higher risk of recurrence (OR = 1.745, 95% CI 1.562, 1.986; p-value = 0.040).
Conclusion:
PFA was associated with a significantly lower recurrence rate in patients > 60 years of age with more comorbidities compared to RFA. However, in patients aged ≤ 60 years, no difference in RFA vs. PFA in terms of recurrence rate was observed. Mean time to recurrence was comparable between PFA and RFA subgroups in the group 1 population, whereas it was significantly higher in group 2 PFA vs. RFA subgroup.
