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

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.