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Article Abstract
Background: The endothelial injury that can promote thrombus formation during radiofrequency ablation (RFA) of atrial fibrillation does not occur with pulsed field ablation (PFA).
Objective: The purpose of this study was to evaluate different strategies for oral anticoagulation (OAC) management following PFA and RFA.
Methods: Consecutive patients undergoing PFA were propensity score matched with consecutive patients undergoing RFA during the same time period (1:1) and prospectively followed up for 15 months. Based on the duration of OAC therapy, patients were classified into PFA/RFA-group 1 (OAC for 1 month) and PFA/RFA-group 2 (OAC for ≥2 months).
Results: A total of 800 patients were included in this analysis: 400 from the PFA population (PFA-group 1: 196; PFA-group 2: 204) and 400 from the RFA population 400 (RFA-group 1: 182; RFA-group 2:218). At follow-up, none of the patients in PFA-group 1 (0%) and 2 patients (0.98%) in PFA-group 2 experienced stroke or transient ischemic attack (TIA). In the RFA cohort, 23 stroke/TIA were reported; 16 (8.8%) and 7 (3.2%) in group 1 and 2 respectively (p=0.017). Compared to the PFA population, total number of events were significantly higher in the overall RFA cohort (0.50% vs 5.8%, p <0.001) as well as in RFA-group 1 (0% vs 8.8%, p<0.001). Arrhythmia-recurrence at 15-month was detected in 73 (18.25%) and 108 (27.0%) (27.4%) patients in the PFA and RFA cohort respectively (p=0.003) CONCLUSION: In this consecutive series, no stroke/TIA were reported in the PFA population after discontinuation of OAC at 1 month, whereas a significantly higher number of strokes were documented after OAC interruption at 1 month in the RFA group.
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