Maurhofer, Jens RudolfJens RudolfMaurhoferKüffer, ThomasThomasKüffer0000-0003-3553-4945Madaffari, AntonioAntonioMadaffariStettler, RobinRobinStettlerStefanova, AnitaAnitaStefanovaSeiler, JensJensSeilerThalmann, GregorGregorThalmannKozhuharov, Nikola AsenovNikola AsenovKozhuharovGaluszka, Oskar MarianOskar MarianGaluszkaServatius, Helge SimonHelge SimonServatiusHäberlin, Andreas David HeinrichAndreas David HeinrichHäberlin0000-0002-9283-0110Noti, FabianFabianNotiTanner, HildegardHildegardTannerRoten, LaurentLaurentRoten0000-0002-0827-1329Reichlin, Tobias RomanTobias RomanReichlin0000-0002-7197-84152025-01-082025-01-082024-03https://boris-portal.unibe.ch/handle/20.500.12422/202378BACKGROUND Pulsed-field ablation (PFA) has shown favourable data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI). We sought to compare procedural and 1-year follow-up data of patients with paroxysmal atrial fibrillation (AF) undergoing PVI using PFA, cryoballoon ablation (CBA) and radiofrequency ablation (RFA). METHODS Consecutive patients with paroxysmal AF undergoing a first PVI with PFA at our institution were included. For comparison, patients with paroxysmal AF undergoing a first PVI with CBA and RFA were selected using a 1:2:2 propensity score matching. The PFA group followed the standard 32-applications lesion-set protocol, the CBA group a time-to-effect plus 2-min strategy, and the RFA group the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of atrial tachyarrhythmia (ATa) following a blanking period of 3 months. RESULTS A total of 200 patients were included (PFA n = 40; CBA n = 80; RFA n = 80). Median procedure times were shortest with CBA (75 min) followed by PFA (94 min) and RFA (182 min; p < 0.001). Fluoroscopy dose was lowest with RFA (1.6Gycm2) followed by PFA (5.0Gycm2) and CBA (5.7Gycm2; p < 0.001). After a 1-year follow-up, freedom from ATa recurrence was 85.0% with PFA, 66.2% with CBA and 73.8% with RFA (p = 0.12 PFA vs. CBA; p = 0.27 PFA vs. RFA). CONCLUSION In a propensity score matched analysis of patients with paroxysmal AF, freedom from any ATa 1 year after PVI using PFA was favourable and at least as good as for PVI with CBA or RFA.enCryoballoon ablation Paroxysmal atrial fibrillation Pulmonary vein isolation Pulsed-field ablation Radiofrequency ablation600 - Technology::610 - Medicine & healtharticle10.48350/1868433777635510.1007/s10840-023-01651-4