What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Fibrillation (n=210). Intervention: Pulsed-field ablation (PFA) vs. Radiofrequency (RF) ablation. Primary outcome: Arrhythmia recurrence after the blanking period (p=>0.99).

July 4, 2025Open Access

Pulmonary vein isolation with radiofrequency ablation and pulsed field ablation: a follow-up with real-world data

Key Result

Pulsed-field ablation resulted in a similar rate of atrial arrhythmia recurrence after the blanking period (34.6%) compared to radiofrequency ablation (33.7%) in patients with atrial fibrillation.

Study Design

Type

Observational (n=210)

Multicenter

Structured PICO

Does pulsed-field ablation prevent arrhythmia recurrence compared to radiofrequency ablation in patients with symptomatic atrial fibrillation?

Population

210 patients with symptomatic paroxysmal (76.2%) or persistent atrial fibrillation undergoing pulmonary vein isolation at a tertiary care center in Poland. Median age 67, 42.4% women.

Intervention

Pulsed-field ablation (PFA) using the Farawave catheter (n=108)

Comparator

Radiofrequency (RF) ablation using a very-high-power, short-duration (vHPSD) catheter or an ablation index-guided catheter (n=102)

Outcome

Freedom from arrhythmia recurrence (atrial fibrillation or atrial tachycardia) after a 3-month blanking period, assessed via Holter ECG at 3, 6, and 12 months postablationhard clinical

Pulsed-field ablation offers comparable efficacy and safety to radiofrequency ablation for pulmonary vein isolation in real-world practice, with significantly shorter procedure times but longer fluoroscopy exposure.

Main Result

Absolute Event Rate: 34.6% vs 33.7%

p-value: p=>0.99

Limitations

Retrospective, non-randomized design
Remote collection of follow-up data may have led to inaccurate recurrence reporting
PFA procedures were performed during the operators' learning curve
Some patients were lost to follow-up
Echocardiographic images could not be presented due to software limitations

Abstract

INTRODUCTION: Currently, the treatment of atrial fibrillation (AF) focuses on restoring sinus rhythm with pulmonary vein isolation (PVI). Pulsed‑field ablation (PFA) is a novel, promising method that requires greater support of real‑world data. OBJECTIVES: Our aim was to assess the rate of arrhythmia recurrence in patients who underwent PVI with either radiofrequency (RF) energy or PFA. PATIENTS AND METHODS: This retrospective analysis included 210 patients with paroxysmal (76.2%) or persistent AF undergoing PVI at a university hospital. The study group consisted of 108 patients who underwent PFA using the Farawave catheter. RF ablations were performed in 102 patients using a very‑high‑power, short‑duration or index‑guided ablation. The primary end point was no recurrence of arrhythmia. RESULTS: There were no significant baseline differences in patient characteristics. Procedural times were shorter with PFA (55 min) than RF (115 min; P 0.99). The overall frequency of adverse events was similar in both groups. CONCLUSIONS: Regardless of the selected method, the efficacy of the procedures remains comparable. There was no significant difference in postoperative adverse events between the groups.

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