Po-01-194 a comparison of clinical outcomes for three different modalities used for pulmonary vein isolation in patients with atrial fibrillation

Pulmonary Vein Isolation (PVI) represents the cornerstone in atrial fibrillation ablation. The two most frequently used technologies for PVI are radiofrequency (RF) and cryoablation (CB). More recently, laser balloon (LB) has emerged as a promising therapy. Studies comparing all three modalities are lacking. We sought to compare clinical outcomes of RF, CB, and LB ablation in patients with atrial fibrillation from a prospective multi center registry. Between January 2018 and December 2021 912 patients from 3 U.S. centers underwent PVI catheter ablation with either RF, CB, or LB. Baseline clinical characteristic and procedural data were obtained (table). Patients were followed for 1 year. The primary outcome was time to atrial fibrillation. Secondary outcomes were time to any arrythmia and time to anti-arrhythmic drug therapy after the 90-day blanking period. A total of 912 patients were enrolled during the study. There were no significant differences at baseline between the groups with regards to sex, age, and prior cardiac history. 331 (36%) patients underwent PVI with CB, 227 (25%) underwent PVI with LB, and 354 (39%) underwent PVI with RF. There was no significant difference in time to recurrence of atrial fibrillation across treatment groups at 180 days (p=0.635) and at 360 days (p=0.425) (Figure). After 360 days there was a trend towards less recurrence of atrial arrythmias in the LB group vs the CB group (p=0.096). Time to use of AADs after the 90-day blanking period was significantly higher in the RF group after 360 days (p=0.009). In the cohort, atrial fibrillation was significantly associated with severe LA dilation [HR 1.841 (95%CI 1.044 to 3.247); p=0.035] and paroxysmal type of AF [HR 0.66 (95% CI 0.45 to 0.98); p=0.038]. The most common complication was groin hematoma. No atrioesophageal fistulae were observed. Death occurred in one patient unrelated to procedure. In this prospective cohort study, recurrence of atrial fibrillation was similar between all modalities at 1 year. There was a trend towards lower recurrence of atrial arrhythmia at 1 year in the LB group compared to the CB group. Patients who underwent RF PVI were more likely to be initiated on AAD therapy after the 90-day blanking period. Predictors of recurrence of AF included a severely enlarged LA and paroxysmal type of AF. Similar rates of procedural complications were seen across all treatment groups.Tabled 1Patient CharacteristicsCharacteristicOverallCryo, NLaser, NRF, Np-valueAge656566650.3Male Sex5572311861400.051Hypertension6812391652770.12Diabetes2006353840.3Coronary artery disease1926452760.6Stroke662511300.2Congestive heart failure168121128135<0.001AAD therapy4191391101700.6Procedure time (min)126121128135<0.001Vascular complications30030.12Post procedural stroke1003>0.9Phrenic nerve palsy72410.13Hematoma3085170.11Death10110.2 Open table in a new tab