Mean pulmonary artery pressures (mPAP) are not worse after pulsed-field ablation (PFA) in patients who have pre-existing pulmonary hypertension (PH) and undergo an additional procedure for recurrence, a new propensity-matched study shows. Sanghamitra Mohanty, MD, MS, of St. David’s Medical Center, Austin, Texas, and colleagues from Belgium, Italy and the U.S., reported these findings in manuscript published Wednesday online in JACC: Clinical Electrophysiology. Atrial fibrillation (AF) is frequently treated using catheter ablation. PFA is a recently released energy system used to perform the procedure. Radiofrequency ablation (RFA) carries a risk of left atrial (LA) diastolic dysfunction and potential subsequent PH development, but few studies have noted the impact of PFA on LA function and mPAP. Investigators in this multicenter study sought to compare baseline PH between non-paroxysmal patients with AF who underwent PFA and RFA. The study assessed the risk of the baseline PH worsening between the two groups. A multivariable logistic model was used for 1:1 propensity score matching. This study included 28 patients (mean age=62.21 ± 9.38 years, 67.9% male) with non-paroxysmal AF and pre-existing PH—which occurred due to previous RFA—who underwent PFA-based repeat ablation procedure after more than one failed RFA between 2022 and 2022. The comparator group consisted of 28 patients (mean age=62.39 ± 9.36 years, 64.3% male) with AF and PH who were scheduled for repeat RFA. PAP was assessed before and after the procedure using right heart catheterization and echocardiography. The definition of PH was a resting mPAP >20 mmHg. Exclusion of pulmonary vein stenosis or occlusion was performed by computed tomography. The primary endpoint of this study was the change in mPAP at 3 months from baseline. Baseline, follow-up and change from baseline mPAPs were analyzed. Average baseline mPAP was similar between groups, at 43.04 mmHg in the PFA group and 39.89 in the RFA group (p=0.177). After an analysis of covariance model was used to adjust for baseline mPAP, the least-squares means change at 3 months post-ablation was -1.71 ± 1.03 mmHg in PFA (for a least-squares mean of 39.75 ± 1.03 mmHg) and 19.67 ± 1.03 mmHg (for a least-squares mean of 61.14 ± 1.032 mmHg) in RFA (p<0.001 for both the least-squares mean values and least-square mean changes). The authors added that every RFA patient had higher mPAP at 3 months compared to baseline, while most PFA patients (89.3%) saw their mPAP either stay steady or drop by 3-month follow-up. Overall, patients with AF and PH who undergo PFA do not experience worsening mPAP, compared with patients who undergo RFA. The investigators in this study recommend avoidance of RFA in this patient population to prevent the risk of worsening the PH. Source: Mohanty S, Della Rocca MG, Torlapati PG, et al. Pulsed-Field Ablation Does Not Worsen Baseline Pulmonary Hypertension Following Prior Radiofrequency Ablations. JACC Clin Electrophysiol. 2023 Dec 20 (Article in press). Image Credit: VectorMine – stock.adobe.com