Quality of life after atrial fibrillation ablation: a comparison of pulsed-field versus radiofrequency energy

Introduction Atrial fibrillation (AF) markedly impairs quality of life (QoL). Catheter ablation improves symptoms beyond rhythm control alone. Pulsed-field ablation (PFA) is rapidly emerging as a next-generation energy source, yet comparative real-world data on QoL versus radiofrequency ablation (RFA) are scarce. Purpose To quantify QoL change one year after AF ablation and compare PFA with RFA. Methods Consecutive AF patients undergoing first-time PVI using PFA or RFA at a tertiary center were prospectively enrolled. QoL was assessed at baseline and one year using EHRA score, EQ-5D-3L and EQ-VAS. Propensity score matching was performed for age, sex, AF type, and cardiovascular comorbidities. Results A total of 638 patients were included (median age 67 years, 33% female, 57% paroxysmal AF), with 319 matched pairs. Procedural time was markedly shorter with PFA (50 vs. 79 minutes, p < 0.001). Both energy sources produced significant and clinically meaningful QoL improvements at one year (Figure). After one year, the proportion of patients in EHRA class I increased from 20% to 76% in the PFA group and from 15% to 72% in the RFA group, with overall EHRA improvement observed in 69% and 74% of patients, respectively (p = 0.125). PFA improved EQ-5D-3L index (0.89±0.19 to 0.92±0.17, p < 0.001) and EQ-VAS (73.6±15.9 to 79.4±14.9, p < 0.001). RFA improved EQ-5D-3L (0.90±0.17 to 0.92±0.17, p < 0.001) and EQ-VAS (74.7±16.1 to 80.2±14.0, p < 0.001). Between-group comparisons showed no significant differences at baseline or one year. Recurrence-free survival at one year was similar between PFA and RFA (70% vs 72%, plog-rank = 0.579). Conclusion AF ablation led to a meaningful improvement in patient-reported QoL, independent of whether the procedure was performed with PFA or RFA. PFA, however, achieved comparable outcomes with substantially shorter procedure times.