Key result
PFA linked to ~12% lower rate of early moderate-to-severe chest pain vs thermal ablation.
Why the study?
Although pulsed-field ablation has transformed AF ablation, how the early patient experience compares with thermal techniques remains unclear.
Does pulsed-field ablation improve early post-procedural patient-reported symptoms compared to thermal ablation in patients undergoing first-time pulmonary vein isolation for atrial fibrillation?
Cohort (n=202)
No
Does pulsed-field ablation improve early post-procedural patient-reported symptoms compared to thermal ablation in patients undergoing first-time pulmonary vein isolation for atrial fibrillation?
Effect estimate: 12.3% for PFA vs 21.2% for CB and 26.2% for RF
p-value: p=<0.001
Pulsed-field ablation is associated with modestly lower immediate post-procedural chest pain compared to thermal ablation methods, with equivalent 3-month patient-reported quality of life.
PFA-associated early chest pain reduction does not support preferential use; leaves open impact on long-term outcomes and ablation selection in AF.
BACKGROUND: Pulsed-field ablation (PFA) has transformed atrial fibrillation (AF) ablation, but how the early patient experience compares with thermal techniques remains unclear. This study aimed to assess patient-reported outcome measures (PROMs) in the first 3 months after PFA or thermal AF ablation, using a novel smartphone-based application. METHODS: Patients undergoing first-time pulmonary vein isolation prospectively completed the Cardiac Ablation Recovery Evaluation (CARE) symptom questionnaire at five timepoints: baseline, day 1, day 7, day 30, and day 90. Symptoms were rated on a 7-point Likert scale (0 = not at all; 6 = extremely). Patients also completed the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire at baseline and day 90. RESULTS: Two hundred and two patients were included (pentaspline PFA: 66; radiofrequency: 64; cryoballoon: 72), with similar baseline demographics between groups, except for a lower prevalence of paroxysmal AF in the PFA group. Engagement with the smartphone-based platform was high, with a 94.7% completion rate. Median AFEQT scores improved from 64 (47-82) at baseline to 86 (72-95) at day 90 (p < 0.001), with no significant differences between modalities (p = 0.841). However, CARE detected differences in early symptom experience: chest pain was lowest with PFA at day 1 (median: PFA, 1 [0-2]; radiofrequency, 2 [1-2]; cryoballoon, 2 [1-2]; p < 0.001), and remained lower than cryoballoon at day 7 (p = 0.019), with differences resolving by day 30. Moderate-to-severe chest pain (score ≥ 3) occurred in only 12.3% of PFA patients at day 1, compared with 21.2% cryoballoon and 26.2% radiofrequency patients (p < 0.001). Palpitations at day 1 were less frequent with PFA than radiofrequency (p = 0.040). Groin discomfort was lower with radiofrequency than PFA or cryoballoon at day 1 (p = 0.006) and day 7 (p < 0.001), likely reflecting a smaller sheath size. CONCLUSIONS: PFA was associated with a modest and transient reduction in early post-procedural chest pain compared with thermal ablation. Smartphone application-based PROMs collection using the CARE questionnaire was feasible, enabling structured assessment of symptom burden across multiple recovery timepoints.
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Mills et al. (2026) conducted a cohort in Atrial Fibrillation (n=202). Pulsed-field ablation vs. Thermal ablation (radiofrequency or cryoballoon) was evaluated on Moderate-to-severe chest pain (score ≥ 3 on CARE questionnaire) at Day 1 (12.3% for PFA vs 21.2% for CB and 26.2% for RF, p=<0.001). Pulsed-field ablation was associated with a modest and transient reduction in early post-procedural moderate-to-severe chest pain compared with thermal ablation techniques.
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