Patient experience following pulsed field ablation compared to radiofrequency ablation for atrial fibrillation

Background Pulsed-field ablation (PFA) for atrial fibrillation (AF) offers several advantages compared to thermal ablation, including selective myocardial tissue ablation, reduced risk of collateral damage to adjacent structures, shorter procedural times, and potentially enhanced lesion uniformity. Despite its growing adoption, direct comparisons of patient-reported outcomes after PFA and radiofrequency ablation (RFA) are limited. The objective of this study was to assess patient experience following PFA or RFA in AF ablation performed under general anesthesia. Methods A retrospective study across a single integrated health system was conducted on consecutive patients who underwent PFA or RFA for AF under general anesthesia between March and June 2024. Data were collected from electronic medical records. Primary endpoints included postprocedural pain complaints and scores, need for analgesic medication, and frequency of emergency department (ED) visits for procedure-related concerns. Continuous variables were analyzed using an unpaired Student’s t-test, and categorical variables were evaluated using χ² tests. Results Two hundred patients (100 PFA and 100 RFA) were analyzed (age 73.2 ±9.2y, 38% female). There were no differences in demographic characteristics between groups. Additional ablation beyond pulmonary vein isolation (PVI) was more common in the RFA group (68 vs. 30, p < .05), consisting of ablation to the mitral isthmus, cavotricuspid isthmus, posterior left atrial wall, and other. Patients undergoing RFA had a significantly higher rate of ED visits within 30 days post-procedure compared to those who underwent PFA (17% vs. 6%, p = <.05). The most common complaints were shortness of breath, chest pain, palpitations, dizziness, lightheadedness, and fatigue. There were no statistically significant differences in postprocedural pain scores (RFA 1.60 vs. PFA 1.57, p = 0.57), requests for analgesic medications (RFA 36 vs. PFA 29, p = 0.365), nor encounters made to the care team within 30 days following the procedure (RFA 57 vs. PFA 43, p = 0.06). Conclusion In this retrospective study of catheter ablation performed under general anesthesia, patients who underwent PFA had fewer ED visits for procedure-related complaints compared to RFA. A higher rate of post-procedural complaints leading ED presentation may be particularly applicable in cases of extensive ablation beyond PVI, which was more common in the RFA group. While these clinical endpoints potentially suggest improved patient comfort and satisfaction with PFA compared to RFA, larger prospective studies using patient-reported outcome measures are warranted.