Pulsed field ablation with the pentaspline catheter vs radiofrequency ablation for recurrent atrial fibrillation

Abstract Background Pulsed field ablation (PFA) is a non-thermal energy modality for catheter ablation. While recent studies have demonstrated that PFA is noninferior to radiofrequency ablation (RFA) for the initial treatment of atrial fibrillation (AF), its comparative efficacy and safety in patients who had AF recurrence following the initial ablation procedure remain unknown. Methods From July 1, 2024 to September 30, 2024, 223 consecutive patients who had AF recurrence following the initial ablation procedure were prospectively enrolled from two participating centers and underwent either PFA using the pentaspline catheter (PFA group, n=77) or RFA (RFA group, n=146) based on clinical judgment. The effectiveness endpoint was freedom from AF/atrial tachycardia (AT) recurrence at 12 months. Results At 12 months, there was no significant difference in the rate of freedom from AF/AT recurrence between the PFA and RFA groups (71.4% vs 67.8%; log-rank P=0.514; HR 0.85, 95% CI 0.52-1.38). Similarly, the incidence of safety endpoints did not differ significantly between the two groups (2.6% vs. 3.4%; P=0.947). Conclusion In patients who had AF recurrence following the initial ablation procedure, PFA using a pentaspline catheter demonstrated comparable effectiveness and safety to RFA, with similar rates of freedom from AF/AT recurrence and adverse events at 12 months.