What is the clinical evidence from this study?

Study design: RCT. Population: paroxysmal atrial fibrillation. Intervention: Pulsed-field ablation (PFA) vs. Cryoballoon ablation (CBA). Primary outcome: Residual pulmonary vein conduction in acute post-ablation mapping (p=0.11).

What question did this study set out to answer?

To compare the effectiveness of pulsed-field ablation and cryoballoon ablation for pulmonary vein isolation in patients with atrial fibrillation.

July 5, 2026EP EuropaceOpen Access

PFA yields similar acute pulmonary vein isolation and chronic durability compared to cryoballoon ablation.

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Why the study?

To compare the effectiveness, acute lesion geometry via 3D electroanatomic mapping, and chronic lesion durability of pulsed-field ablation versus cryoballoon ablation for pulmonary vein isolation in paroxysmal AF.

Does pulsed-field ablation compared to cryoballoon ablation improve acute and chronic pulmonary vein isolation and lesion geometry in patients with paroxysmal atrial fibrillation?

Comparison

Fluoroscopy-guided PVI with PFA vs CBA

Design

Prespecified sub-study of a 1:1 randomized multicenter trial

Key result

Pulsed-field ablation resulted in 0% acute residual pulmonary vein conduction versus 16% with cryoballoon ablation (P=0.11), and similar chronic durability at repeat ablation (15% vs 14%).

Authors

TKThomas Kueffer SKSven Knecht EAE Ayadi

Discussion

Member takes

Overview

Acute 3D-EAM shows complete PVI after PFA but residual conduction in 16% after CBA; leaves open durability and outcome impact.

Key Points

To compare the effectiveness of pulsed-field ablation and cryoballoon ablation for pulmonary vein isolation in patients with atrial fibrillation.
Patients randomized 1:1 to receive PFA or CBA for pulmonary vein isolation.
High-density 3D electroanatomic mapping performed on initial 25 patients post-ablation.
Assessment of lesion geometry and durability evaluated during follow-up ablation procedures.
Acute post-ablation mapping showed 16% residual conduction in CBA vs. 0% in PFA (P=0.11).
PFA produced larger left-sided lesions with median area of 5.7 mm² compared to 4.4 mm² for CBA (P=0.026).
Durable pulmonary vein isolation was achieved in 62% of veins after PFA and 63% after CBA (P=0.88).

Study Design

Type

RCT

Randomization

1:1

Multicenter

Yes

Structured PICO

Does pulsed-field ablation compared to cryoballoon ablation improve acute and chronic pulmonary vein isolation and lesion geometry in patients with paroxysmal atrial fibrillation?

Population

Patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation, evaluated with acute post-ablation mapping (n=50) and at repeat ablation (n=48).

Intervention

Fluoroscopy-guided pulmonary vein isolation with pulsed-field ablation (PFA)

Comparator

Fluoroscopy-guided pulmonary vein isolation with cryoballoon ablation (CBA)

Outcome

Acute pulmonary vein isolation, lesion geometry (assessed via 3D-EAM), and lesion durability at clinically indicated repeat ablationsurrogate

Main Result

Absolute Event Rate: 0% vs 16%

p-value: p=0.11

Pulsed-field ablation and cryoballoon ablation demonstrate similar chronic pulmonary vein isolation durability, although PFA creates broader acute left-sided lesions and carries a risk of unintentional posterior wall block in small atria.

Cite This Study

Kueffer et al. (2026) conducted an RCT in paroxysmal atrial fibrillation. Pulsed-field ablation (PFA) vs. Cryoballoon ablation (CBA) was evaluated on Residual pulmonary vein conduction in acute post-ablation mapping (p=0.11). Pulsed-field ablation resulted in 0% acute residual pulmonary vein conduction versus 16% with cryoballoon ablation (P=0.11), and similar chronic durability at repeat ablation (15% vs 14%).

synapsesocial.com/papers/6a49f70df5d1d45b2880125e https://doi.org/10.1093/europace/euag167

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July 5, 2026EP EuropaceOpen Access

PFA yields similar acute pulmonary vein isolation and chronic durability compared to cryoballoon ablation.

View Full Paper

Ask AI

Bookmark

Why the study?

Does pulsed-field ablation compared to cryoballoon ablation improve acute and chronic pulmonary vein isolation and lesion geometry in patients with paroxysmal atrial fibrillation?

Comparison

Fluoroscopy-guided PVI with PFA vs CBA

Design

Prespecified sub-study of a 1:1 randomized multicenter trial

Key result

Pulsed-field ablation resulted in 0% acute residual pulmonary vein conduction versus 16% with cryoballoon ablation (P=0.11), and similar chronic durability at repeat ablation (15% vs 14%).

Authors

TKThomas Kueffer SKSven Knecht EAE Ayadi

Discussion

Member takes

Overview

Acute 3D-EAM shows complete PVI after PFA but residual conduction in 16% after CBA; leaves open durability and outcome impact.

Key Points

To compare the effectiveness of pulsed-field ablation and cryoballoon ablation for pulmonary vein isolation in patients with atrial fibrillation.
Patients randomized 1:1 to receive PFA or CBA for pulmonary vein isolation.
High-density 3D electroanatomic mapping performed on initial 25 patients post-ablation.
Assessment of lesion geometry and durability evaluated during follow-up ablation procedures.
Acute post-ablation mapping showed 16% residual conduction in CBA vs. 0% in PFA (P=0.11).
PFA produced larger left-sided lesions with median area of 5.7 mm² compared to 4.4 mm² for CBA (P=0.026).
Durable pulmonary vein isolation was achieved in 62% of veins after PFA and 63% after CBA (P=0.88).

Study Design

Type

RCT

Randomization

1:1

Multicenter

Yes

Structured PICO

Does pulsed-field ablation compared to cryoballoon ablation improve acute and chronic pulmonary vein isolation and lesion geometry in patients with paroxysmal atrial fibrillation?

Population

Patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation, evaluated with acute post-ablation mapping (n=50) and at repeat ablation (n=48).

Intervention

Fluoroscopy-guided pulmonary vein isolation with pulsed-field ablation (PFA)

Comparator

Fluoroscopy-guided pulmonary vein isolation with cryoballoon ablation (CBA)

Outcome

Acute pulmonary vein isolation, lesion geometry (assessed via 3D-EAM), and lesion durability at clinically indicated repeat ablationsurrogate

Main Result

Absolute Event Rate: 0% vs 16%

p-value: p=0.11

Cite This Study

synapsesocial.com/papers/6a49f70df5d1d45b2880125e https://doi.org/10.1093/europace/euag167

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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