Perioperative parameters and myocardial necrosis: a real-world comparison of Farapulse and Varipulse

Pulsed field ablation (PFA) has emerged as a promising method for pulmonary vein isolation (PVI) due to its myocardial-selective mechanism and a favorable safety profile. Among the available technologies, Farapulse (Boston Scientific Corporation, Marlborough, USA) and Varipulse (Biosense Webster Inc, New Brunswick, USA) are the two leading PFA systems. However, comparative data regarding their perioperative performance and impact on myocardial injury remain limited. This study aimed to evaluate and compare perioperative outcomes and myocardial injury, assessed by postprocedural troponin I levels, in patients undergoing first-time PVI with the Farapulse or Varipulse system in a real-world clinical setting.

In this prospective analysis of 50 patients with symptomatic atrial fibrillation (AF) undergoing first-time PVI, Farapulse (n = 25) and Varipulse (n = 25) systems were compared by assessing procedure duration, fluoroscopy time, 12-hour postprocedural troponin I levels, first-pass isolation (FPI) rates, and periprocedural complications (atrial-esophageal fistula, periprocedural stroke, pseudoaneurysm, vascular complications, and AF recurrence before discharge).

Farapulse-based procedures were shorter than those performed using the Varipulse system (median duration 50 vs. 55 min; p <0.001) but were associated with longer fluoroscopy times (median, 646 vs.177 s; p <0.001) and higher median troponin levels (15386 vs. 9937 ng/L; p <0.001). No significant differences were observed in FPI (76% vs. 56%; p = 0.23) or complication rates.

In a real-world cohort, Farapulse was associated with shorter procedure times, while Varipulse, aided by 3D mapping, was linked to reduced fluoroscopy exposure and lower troponin release. These findings highlight the need for further studies on long-term outcomes and optimization across different PFA systems.