Pulsed electric field and radiofrequency ablation for paroxysmal supraventricular tachycardia: a propensity score-matched comparison (PFA-SVT study).

BACKGROUND

Preliminary studies have demonstrated the feasibility of pulsed field ablation (PFA) for the treatment of paroxysmal supraventricular tachycardia (PSVT); however, direct comparative data between PFA and radiofrequency ablation (RFA) with longer-term follow-up are lacking.

OBJECTIVE

This study aimed to compare the safety and efficacy profiles of PFA and RFA in PSVT treatment through propensity score matching over a 12-month follow-up period.

METHODS

This multicenter prospective study enrolled 621 consecutive patients with PSVT who underwent catheter ablation with PFA (n = 212) or RFA (n = 409) across 8 centers in China. Propensity score matching was performed separately for atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) patients, yielding 107 and 67 matched pairs. The primary and secondary end points were acute ablation and 12-month follow-up success rates, respectively.

RESULTS

The acute procedural success rate was 100% for both modalities in all matched patients. The 12-month success rates were comparable between the PFA and RFA groups for both AVNRT (97.2% vs. 96.3%, P = 0.701) and AVRT (92.5% vs. 89.6%, P = 0.545). In the AVNRT cohort, all PFA recurrences were observed between 6 and 12 months. Although PFA required more ablation applications (AVNRT: 11.5 vs. 9.0, P < 0.001; AVRT: 15.5 vs. 7.0, P < 0.001), the overall procedure time remained comparable to that of RFA. Transient first-degree AV block was observed in one patient per group in the matched AVNRT cohort and in one RFA-treated patient in the matched AVRT cohort. All patients resolved spontaneously without permanent complications.

CONCLUSIONS

PFA demonstrated safety and efficacy outcomes comparable to those of RFA, supporting its potential role as an alternative therapeutic option for PSVT management. These findings should be considered hypothesis-generating, and further large-scale randomized trials with longer follow-up and different PFA systems are required for confirmation.