Comparison of room times between pulsed-field ablation and very high-power short-duration ablation

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Background Pulsed-field ablation (PFA) has shown promise in improving atrial fibrillation (AF) ablation efficiency by reducing skin-to-skin procedure times while maintaining safety compared with advanced radiofrequency methods such as very high-power short-duration (vHPSD) ablation. Although PFA requires deeper sedation, its effect on total time spent in the operating room is unknown. Objective We aimed to compare the room time (the time between operating room entry and exit) and procedural subsections' times of PFA and vHPSD procedures. Methods We enrolled consecutive patients who underwent PFA or vHPSD ablation at our center. Room and procedural subsections' times were analyzed. Recurrence rates at 6 months were also compared. Results We included 131 patients (66 [55–71] years, 86 [65.6%] had paroxysmal AF). Eighty-seven patients (66%) underwent PFA, and 44 (34%) underwent vHPSD ablation. PFA outperformed vHPSD in terms of room time (71 [64–80] vs 88 [75–99.8] minutes, P < .001) and in most procedural subsections. One major nonfatal complication occurred with PFA, whereas no major complication occurred with vHPSD. There was no significant difference in 6-month recurrence rates between the 2 groups (PFA 15%, vHPSD 18%, P = .646). Conclusion In AF ablation, PFA results in significantly shorter room time than vHPSD, while maintaining similar 6-month recurrence rates. PFA may enhance time efficiency in the electrophysiology laboratory, even compared with the fastest radiofrequency technology.

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