Pulsed field ablation with a pentaspline catheter and concomitant left atrial appendage closure for long-standing persistent atrial fibrillation: Comparison with a radiofrequency cohort.

BACKGROUND

Pulsed field ablation (PFA) is increasingly being adopted for atrial fibrillation (AF) ablation, but outcome data, when it is combined with left atrial appendage occlusion (LAAO), remain limited.

OBJECTIVE

We evaluated outcomes of extensive PFA combined with LAAO, compared with radiofrequency ablation plus LAAO in patients with long-standing persistent AF.

METHODS

In this observational, multicenter, propensity-matched study, 90 consecutive patients with drug-refractory, long-standing persistent AF underwent combined ablation (pulmonary veins, posterior wall, and LAA electrical isolation) plus LAAO (45 PFA, 45 RF). Matching was 1:1 based on age, CHA2DS2-VASc score, HAS-BLED score, and LAAO device. Follow-up was censored at 12 months.

RESULTS

Baseline characteristics were balanced after matching. Procedural time was shorter with PFA than RF (86.0 ± 6.8 vs 114.5 ± 11.5 minutes, P = 0.042). Acute LAAO success was 100% in both groups, with similar complication rates (1 pericardial effusion each). Overall peri-device leak (PDL) incidence was lower with PFA (8.9% vs 24.4%, P = 0.048), although clinically relevant leaks >3 mm were infrequent and comparable (0% vs 4.4%, P = 0.494). At 12 months, arrhythmic recurrences were numerically lower with PFA (22.2% vs 40.0%, P = 0.069; log-rank P = 0.093). No strokes or major bleeding occurred in the PFA cohort, whereas 1 non-cardioembolic stroke and 2 major bleeding events occurred in the RF group. In Cox regression, only AF duration >18 months predicted recurrence (hazard ratio = 3.27, 95% confidence interval 1.15-9.32; P = 0.027).

CONCLUSION

Extensive PFA, including LAA electrical isolation, combined with LAAO was feasible and safe, resulting in shorter procedures, fewer overall PDLs compared with RF but similar rate of PDL >3 mm.