Pulsed Field Ablation: an Innovative and Efficient Alternative to Radiofrequency Ablation

The aim of this thesis was to compare the efficacy, safety and procedural outcomes of pulsed field ablation (PFA) and RFA in the treatment of AF across two comparable populations. PFA employs electroporation, a non-thermal mechanism, to ablate myocardial tissue selectively while avoiding damage to structures like oesophagus and phrenic nerve. This evaluation sought to identify the advantages and challenges associated with PFA and assess its potential to provide an innovative and efficient alternative to the traditional RFA. The study involved creating a database of all the relevant data from both groups and their respective treatments. Data was collected during the procedures performed at the Arcispedale Sant’Anna of Ferrara. The study population, procedural workflow, and statistical analysis methods were described. Statistical analyses were performed using MATLAB version R2024a, with comparisons made using parametric and non-parametric tests as appropriate.The isolation of the pulmonary veins was achieved in all procedures in both groups. However, the total procedural time was significantly shorter in the PFA group compared to the RFA group, while fluoroscopy time was longer for PFA due to the lack of a compatible mapping system. Furthermore, the relapse rate analysis suggested that PFA might offer greater efficacy than RFA in treating persistent atrial fibrillation (PerAF). PFA demonstrates a shorter procedural time and less operator dependence compared to RFA, although it currently requires longer fluoroscopy time due to technological limitations. The study indicates that PFA could be a promising alternative to RFA, offering improved efficiency and potentially better outcomes in AF treatment.