Real-World 6-Month Outcomes With Pulsed Field Ablation in Atrial Fibrillation: A Multicenter Retrospective Analysis in United States Patients

Background/Significance:

Pulsed field ablation (PFA) is a novel non-thermal atrial fibrillation (AF) ablation modality demonstrated to have similar efficacy to traditional thermal ablation in AF. Few reports of multicenter, real-world data about outcomes in treatment of paroxysmal (PAF) and non-paroxysmal (NPAF) with PFA exist.

Purpose:

We aimed to determine 6-month post-procedural freedom from atrial arrhythmias in consecutive patients with AF undergoing ablation at PFA naive centers in the US.

Methods:

Patients with any AF and no prior left-sided ablation who underwent PFA at any of 3 centers from March to May 2024 were included. Arrhythmia recurrence was defined as any atrial arrhythmia lasting ≥30 seconds after the 90-day post-procedure blanking period. Categorical values are presented as n (%) and continuous variables as mean ± standard deviation or median (Q1-Q3). PAF vs. NPAF characteristics were compared using the chi-square and Wilcoxon Rank Sum tests. Kaplan-Meier analysis with a 95% confidence interval was used to estimate freedom from any atrial arrhythmia recurrence at 6 months.

Results:

Of the 149 patients, 31% were female and median age was 67 (61-72) years. The PAF group had 97 (65%) patients, the NPAF group 52 (35%). Baseline characteristics were not significantly different (P>0.05) between the PAF and NPAF groups: CHA2DS2-VASc score (2.5±1.6 vs. 2.4±1.2), prior stroke (5 [5%] vs. 1 [2%]) and prior use of antiarrhythmics (56 [58%] vs. 35 [67%]). The NPAF group had a significantly higher prevalence of congestive heart failure (24 [46%] vs. 20 [21%], P=0.001). Median procedure time was 96 [78-131] minutes in the PAF group and 115 [75-150] minutes in the NPAF group (P>0.5). Median fluoroscopy time was 22 [14-31] minutes in the PAF group and 17 [12-31] minutes in the NPAF group (P>0.5) Thirty-seven (77%) patients in the NPAF group had additional lesions beyond pulmonary vein isolation (PVI), compared with 54 patients (57%) in the PAF group (P=0.08). At the 180-day follow-up, the Kaplan-Meier estimate of arrhythmia-free survival in the whole population was 77% (76% NPAF vs. 78% PAF, P=0.56).

Conclusion:

Among multiple centers and experienced operators, PFA allowed for efficacious 6-month ablation outcomes regardless of AF type or lesion set variation. Future research will focus on long-term outcomes.