The Heart Rhythm Society’s 2024 Annual Meeting (HRS2024) was held in Boston from May 16-19, 2024. This prestigious event showcased cutting-edge research and advancements in the fields of cardiology and electrophysiology (EP). Today, we will explore some of the fascinating research presented at the HRS2024 Annual Meeting, with a specific focus on pulsed field ablation. Below, you will find the poster title, a brief key points taken from the research, and a direct link to access the abstract.

Pulsed-Field Ablation Versus Thermal Ablation for Atrial Fibrillation: A Meta-Analysis

  • The purpose of this study was to compare the acute and long-term efficacies and safety of PFA and TA.
  • Compared to TA, PFA showed better results with regard to acute and long-term efficacy but significant differences in safety, with lower (peri)esophageal injury rates but higher tamponade rates and procedural data.
  • Abstract

Predictors of Atrial Fibrillation Freedom Using Pulsed Field vs. Thermal Catheter Ablation for the Treatment of Atrial Fibrillation – Results of the ADVENT Study

  • To evaluate predictors of long-term treatment success (single procedure, off antiarrhythmic drugs (AADs)) in patients with PAF treated with PFA versus thermal ablation.
  • In this prospective, randomized study evaluating PFA for PAF, there were no differences in type of arrhythmia recurrence among patients treated with PFA, Cryo, and RF ablation. Patients with prior failure of Class I/III AADs experienced improved outcomes with PFA compared to thermal ablation, which may have been driven by the RF treatment group.
  • Abstract

Autonomic Effects of Pulsed Field Compared to Thermal Ablation for Treating Atrial Fibrillation: sub-analysis of the ADVENT Trial

  • To compare heart rate (HR) and heart rate variability (HRV) metrics as surrogates of autonomic function after AF ablation using PFA versus thermal ablation.
  • PFA has minimal effect on the autonomic nervous system compared to thermal ablation. Whether this affects long-term freedom from AF or symptomatic bradycardia/pauses after AF ablation requires further study.
  • Abstract

Complete Fluoroless Pulmonary Vein Isolation Using a Novel Single-Shot Pulsed Field Ablation System: A Sub-analysis of the First-in-Human Experience from the RESET-AF Trial

  • This first-in-human study (RESET-AF) evaluated the feasibility, efficacy and safety of pulmonary vein isolation (PVI) using a novel, single-shot (i.e. without catheter repositioning), PFA system (CRC EP, Inc.). It delivers QRS-gated, bipolar, biphasic electric fields (>2kV) through a spiral, 8.4-Fr, 16-electrode mapping/ablation catheter (ElePulse) available in 2 diameters (25&30-mm).
  • Fluoroless PVI in patients with AF using a novel, spiral-catheter PFA system minimizes repositioning, enabling rapid fluoroless PVI.
  • Abstract

First-in-Human Experience from the RESET-AF Trial: The 6-month Outcomes of PVI Using a Novel Single-Shot Pulsed Field Ablation System

  • The aim of this first-in-human study (RESET-AF) was to evaluate the feasibility, efficacy and safety of PVI using a novel, single-shot (i.e. without catheter repositioning), QRS-gated PFA system (CRC EP) delivering bipolar, biphasic electric fields (>2kV) through a spiral, 8.4-Fr, 16-electrode mapping/ablation catheter (ElePulse, CRC EP) available in 2 sizes (25-/30-mm diameter).
  • In this first-in-human clinical trial, acute PVI was achieved safely and effectively in 100% of the PVs in patients with paroxysmal/persistent AF using a novel, single-shot PFA system without repositioning the catheter. This was associated with a 91.7% PVI durability validated at a 3 month repeat mapping study and 100% freedom from recurrent AF at 6 months.
  • Abstract

Initial Experience of Point-by-Point Pulsed Field Ablation in Complex Cases of Atrial Tachycardia: Feasibility, Outcome and Safety of a Novel Technology

  • The aim of this study was to evaluate feasibility, safety and outcomes of focal PFA in cases of AT.
  • Applying focal PFA with well-known RF ablation catheters is safe and efficient in complex cases of AT. Integration of this system into clinical practice is feasible and did not prolong the procedures. Acute procedure success was achieved in all cases. 
  • Abstract

Comparison of Periprocedural Deep Sedation in Patients Undergoing Pulsed Field or Cryoballoon Ablation for Atrial Fibrillation

  • The aim of this study was to assess differences in sedation and analgesia requirement, procedural cardiopulmonary stability, and analgosedation-associated complications between PFA and CB ablation.
  • Pulsed field ablation is associated with higher sedation and especially analgesia requirement compared to cryoballoon ablation, however, the safety of deep sedation does not differ significantly to cryoballoon ablation.
  • Abstract

Pulsed Field Ablation as a First-line Therapy for Persistent Atrial Fibrillation – Sub-study of the EU-PORIA Registry

  • This study examined the EU-PORIA registry to characterize the real-world use of PFA as a first-line therapy for persistent AF.
  • Pulsed field ablation is associated with higher sedation and especially analgesia requirement compared to cryoballoon ablation, however, the safety of deep sedation does not differ significantly to cryoballoon ablation.
  • Abstract

Pulsed Field Ablation as a First-line Therapy for Paroxysmal Atrial Fibrillation – Sub-study of the EU-PORIA Registry

  • Characterize the real-world use of PFA as a first line therapy in patients with PAF.
  • In this registry, “first-line” PAF patients had similar outcomes to patients with prior Class I/III AAD use. This finding may be driven by multiple factors, including individual physician choice to ablate vs to prescribe AADs and a ceiling effect wherein the already very high procedural effectiveness of this novel PFA system allows less room for benefit of early treatment than what has been previously reported. These promising results warrant further evaluation to characterize PFA as a first-line therapy.
  • Abstract

Thank you for joining us for this recap of the HRS2024 Annual Meeting. We recommend visiting this link to explore the entirety of these posters as well as the remaining posters that were showcased during the event.

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