What is the clinical evidence from this study?

Study design: Cohort. Population: Persistent atrial fibrillation (n=156). Intervention: FARAPULSE pulsed-field ablation (PFA). Primary outcome: Atrial tachyarrhythmias (AF recurrences and atrial flutter episodes).

What does this research mean for the field?

Extended pulsed-field ablation using FARAPULSE in persistent atrial fibrillation maintained sinus rhythm in 76% of patients and improved left ventricular ejection fraction from 46% to 55%. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to evaluate the efficacy of FARAPULSE pulse-field ablation in patients with persistent atrial fibrillation.

February 6, 2026

Efficacy and safety of extended pulsed-field ablation in persistent atrial fibrillation

Key Result

Extended pulsed-field ablation using FARAPULSE in persistent atrial fibrillation resulted in a 24% rate of atrial tachyarrhythmia recurrence over a mean follow-up of 270 days.

Key Points

The aim is to evaluate the efficacy of FARAPULSE pulse-field ablation in patients with persistent atrial fibrillation.
156 patients with persistent atrial fibrillation underwent pulse-field ablation using FARAPULSE.
Extended pulmonary vein isolation included posterior wall and mitral isthmus isolation.
Mean follow-up period was 270 days, assessing recurrences of atrial tachyarrhythmias.
Successful isolation of all pulmonary veins and posterior walls.
Mitral isthmus block achieved in all but two patients.
24% of patients experienced atrial tachyarrhythmias (32 AF recurrences and 6 atrial flutter episodes).
Mean left ventricular ejection fraction improved from 46% to 55%.

Study Design

Type

Cohort (n=156)

Structured PICO

Does extended pulsed-field ablation (including posterior wall and mitral isthmus isolation) effectively maintain sinus rhythm and improve left ventricular function in patients with persistent atrial fibrillation?

Population

156 patients (14% female, mean age 60 years) with persistent atrial fibrillation undergoing extended pulsed-field ablation, followed for a mean of 270 days.

Exposure

Extended pulsed-field ablation (PFA) using FARAPULSE, involving pulmonary vein isolation, posterior wall isolation (in 97% of patients), and mitral isthmus ablation (in 85% of patients).

Outcome

Recurrence of atrial tachyarrhythmias (atrial fibrillation or atrial flutter) over a mean follow-up of 270 days.

Extended pulsed-field ablation including the posterior wall and mitral isthmus is a safe and effective strategy for maintaining sinus rhythm and improving left ventricular function in patients with persistent atrial fibrillation.

Abstract

Abstract Introduction Persistent atrial fibrillation (AF) presents significant challenges for rhythm control, and comprehensive ablation strategies are being explored to enhace outcomes. Pulse-field ablation (PFA) with FARAPULSE offers a non-thermal approach that may approach that may yield superior safety and efficacy. Purpose Purpose The aim is to evaluate the efficacy of FARAPULSE PFA in patients with persistent atrial fibrillation by performing an extended pulmonary vein ablation (PVI) that includes the posterior wall and mitral isthmus isolation. Methods A total of 156 patients with persistent AF underwent PFA using FARAPULSE between November 2022 and August 2024. The cohort included 134 men (86%), with a mean age of 60±10 years. The mean left ventricular ejection fraction (LVEF) prior to the procedure was 46±15%, and the average duration of AF was 389±116 days. Ablation involved PV isolation, posterior wall isolation in 145 (97%) patients, and mitral isthmus ablation in 130 patients (85%). Results All PVs and posterior walls were successfully isolated, with mitral isthmus block achieved in all but two patients. Over a mean follow-up of 270 days, 38 patients (24%) experienced atrial tachyarrhythmias (32 AF recurrences and 6 atrial flutter episodes). Kaplan-Meier analysis illustrated these outcomes (Figure 1). Post-ablation, mean left ventricular ejection fraction (LVEF) improved to 55±8 %. Only two patients experienced complications: one case of vascular complication requiring surgery and one case of hemoglobinuria with reversible renal insufficiency. Conclusion (s) Extended ablation using FARAPULSE PFA in patients with persistent AF effectively maintains sinus rhythm in a significant proportion of cases and leads to notable improvement in left ventricular function. Further studies with extended follow-up are recommended to confirm these findings.

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