Association between early and late atrial tachyarrhythmia recurrences after pulsed field ablation for atrial fibrillation: A systematic review and meta-analysis

BACKGROUND Pulsed field ablation (PFA) has emerged as a tissue-selective modality for atrial fibrillation (AF) ablation. Early recurrence of any atrial tachyarrhythmia (ERAT) during the blanking period are considered transient, however their association with late recurrence of any atrial tachyarrhythmias (LRAT) remains unclear. OBJECTIVE The present meta-analysis aimed to elucidate the association between ERAT and LRAT post-PFA for different blanking cut-offs. METHODS A search of MEDLINE, Scopus, and Cochrane (up to January 12, 2026) identified observational or randomized studies of PFA with ≥1-year follow-up. Double independent study selection, data extraction and quality assessment were performed. Random-effects frequentist models were used to pool odds ratios (OR), hazard ratios (HR), proportions and diagnostic accuracy measures with 95% confidence intervals (CI). RESULTS Seven observational studies (3003 patients) were analyzed. ERATs within 0-90 days were strongly associated with LRATs (OR=8.98, 95%CI=[5.61,14.37]; I2=68%; 7 studies), without subgroup differences by AF type, use of event recorders or PFA technology. The positive predictive value (PPV) of ERATs was 0.66 (95%CI=[0.55,0.76]; I2=75%; 7 studies) within 0-90 days, 0.73 (95%CI=[0.63,0.81]; I2=23%; 3 studies) within 0-60 days and 0.56 (95%CI=[0.16,0.90]; I2=85%; 2 studies) within 0-30 days. ERATs within 0-90 days demonstrated high specificity (0.93, 95%CI=[0.90,0.95]) and positive likelihood ratio (5.83, 95%CI=[4.09,8.32]) for LRATs. Age, heart failure and non-pulmonary vein ablation were significant effect modifiers in metaregression analysis. CONCLUSIONS ERATs within 0-90 days and 0-60 days post-PFA are robust LRAT predictors, whereas first-month ERATs remain insufficiently investigated. Further studies are required to define the optimal blanking period post-PFA.