What question did this study set out to answer?

This research aims to compare procedural characteristics and outcomes between different pulsed field ablation systems for treating atrial fibrillation.

June 29, 2026Journal of Interventional Cardiac Electrophysiology1 citationsOpen Access

Procedural characteristics and acute outcomes with different pulsed field ablation systems for atrial fibrillation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=150). Intervention: Pulsed field ablation systems (Farawave, Faraview, Varipulse) vs. Comparison between systems. Primary outcome: Procedure time (minutes) (p=<0.001).

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Key Result

In patients undergoing pulsed field ablation for atrial fibrillation, the Varipulse system was associated with longer procedure times but shorter fluoroscopy times compared to the Farawave and Faraview systems, with no significant difference in acute adverse events.

Key Points

This research aims to compare procedural characteristics and outcomes between different pulsed field ablation systems for treating atrial fibrillation.
Comparative observational study of 150 patients using three PFA systems: Farawave, Faraview, and Varipulse.
All patients underwent pulmonary vein isolation with additional lesions as needed.
Procedural workflows and outcomes were assessed, including ablation site, application rates, and adverse events.
More patients received posterior wall ablation with Faraview (50%) than with Varipulse (26%) and Farawave (24%) (p = 0.01).
Faraview had significantly more PV applications (52) compared to Farawave (36) (p < 0.001).
No significant difference in major or minor adverse events was observed among the groups.

Study Design

Type

Observational (n=150)

Multicenter

Structured PICO

Do procedural characteristics and acute outcomes differ between different pulsed field ablation systems (Farawave, Faraview, Varipulse) in patients with atrial fibrillation?

Population

150 patients (median age 63-65 years, 33% female) with paroxysmal or persistent atrial fibrillation undergoing de novo pulsed field ablation, evaluated for acute procedural outcomes and 30-day adverse events.

Exposure

Pulsed field ablation using Faraview (with integrated electroanatomic mapping) or Varipulse systems, including pulmonary vein isolation with additional lesions at operator discretion.

Comparator

Pulsed field ablation using Farawave (without electroanatomic mapping).

Outcome

Procedural characteristics including procedure time, left atrial catheter dwell time, fluoroscopy time, and number of applications.surrogate

Different pulsed field ablation systems for atrial fibrillation exhibit varying procedural workflows, times, and fluoroscopy requirements, though acute safety profiles appear similar.

Main Result

Absolute Event Rate: 104% vs 81%

p-value: p=<0.001

Limitations

Single tertiary centre observational study biased by operator preference.
Limited to procedural workflow and short-term (30-day) follow-up.
Not powered to detect differences in rarer adverse events.
Varipulse platform was introduced at a later stage, potentially influencing operator familiarity.
No routine assessment for subclinical haemolysis or acute kidney injury.

Abstract

BACKGROUND: Multiple different pulsed field ablation (PFA) systems have been developed for the treatment of atrial fibrillation (AF). An improved understanding of procedural workflow and outcomes are needed. METHODS: We performed a comparative observational study of consecutive patients undergoing PFA with three systems at a tertiary centre: Farawave without electroanatomic mapping (Boston Scientific, US), Faraview with integrated electroanatomic mapping (Boston Scientific, US) and Varipulse (Johnson and Johnson MedTech, US). All patients underwent pulmonary vein isolation (PVI) with additional lesions at operator discretion. RESULTS: A total of 150 patients undergoing PFA were included (50 with each system). Median age was 63-65 years (p = 0.28) and 28-38% female (p = 0.60). Persistent AF ranged from 40 to 62% (p = 0.09). More patients received posterior wall (PW) ablation with Faraview (50%) compared with Varipulse (26%) and Farawave (24%) (p = 0.01). Faraview was associated with more PV applications (52 versus 36; p < 0.001) although fewer PW applications (18 versus 24; p = 0.028) compared with Farawave. Procedure and left atrial catheter dwell times were higher with Varipulse compared with Farawave and Faraview (p < 0.001), but fluoroscopy time was lower (p < 0.001). Fluoroscopy use with Varipulse reduced in the second 25 cases compared with the first 25 cases (p = 0.01). There was no difference in rate of major or minor adverse events between groups. CONCLUSIONS: These real-world data on different PFA systems highlight varying procedural workflows depending on catheter design and the availability of additional information such as electroanatomic mapping and tissue contact. Further randomised studies are needed to compare safety and efficacy of different PFA systems for AF.

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