Impact of the number of farapulse pulsed-field applications on atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation

Background Pulsed-field ablation (PFA) has emerged as a highly effective energy source for catheter ablation in patients with paroxysmal atrial fibrillation (PAF). Initial recommendations for the Farapulse system suggested 8 applications per vein during pulmonary vein isolation (PVI). The objective of this study was to evaluate whether the total number of PFA applications influences sinus rhythm maintenance and atrial fibrillation (AF) recurrence. Methods A total of 130 patients with PAF (M/F 86/44), mean age 59 ± 10 years, underwent catheter ablation using the Farapulse system. The mean number of applications delivered was 62 ± 17. Antiarrhythmic medications were discontinued post-procedure in most patients except for beta-blockers. Follow-up visits were scheduled at 3, 6, and 12 months. All patients underwent at least a 24-hour Holter ECG; the majority also completed a 7-day ECG monitoring period. Results Based on clinical evaluation and ECG monitoring, sinus rhythm was maintained in 90% and 94% of patients at 3 and 6 months, respectively. The number of PFA applications did not have a statistically significant association with AF recurrence at 3 months (OR 0.99; 95% CI –0.041 to 0.019; p = 0.47) or 6 months (OR 0.98; 95% CI 0.95–1.02; p = 0.237). Although each additional application was associated with an approximate 1% reduction in the likelihood of AF recurrence, this trend did not reach statistical significance. Conclusion In patients with paroxysmal AF undergoing PVI using the Farapulse PFA system, a higher number of pulsed-field applications did not significantly improve short-term sinus rhythm maintenance. A non-significant trend toward reduced AF recurrence with increasing application count was observed. Further studies with larger cohorts and longer follow-up are required to determine the optimal application strategy during PFA-guided PVI.