Key result
PFA accounts for ~49% of first AF ablations, driven primarily by procedural time efficiency.
Why the study?
Pulsed field ablation has rapidly emerged for pulmonary vein isolation with unprecedented adoption across Europe, motivating a survey to characterize current practice patterns.
Cross-Sectional (n=216)
Yes
Pulsed field ablation has experienced rapid adoption for atrial fibrillation ablation in Europe, but significant practice heterogeneity highlights the urgent need for standardized protocols.
AIMS: Pulsed field ablation (PFA) has rapidly emerged as a non-thermal ablation technology for pulmonary vein isolation (PVI), with an unprecedented adoption across Europe. The aim of this survey was to characterize current practice patterns. METHODS AND RESULTS: The European Heart Rhythm Association (EHRA) Scientific Initiatives Committee designed a 30-item questionnaire addressing temporal adoption of PFA, pre-, intra-, and post-procedural workflows, and future perspectives. The survey was distributed between April and June 2025. A total of 216 responses were obtained from 43 countries. At the time of the survey, 23% of respondents had not yet initiated a PFA programme. Overall, PFA is now used in half (49%) of first atrial fibrillation (AF) ablation procedures. Adoption was significantly higher in high-volume centres and 'Western European' countries. The primary driver for adoption was time efficiency (60%). Intra-procedural workflows showed marked heterogeneity: approximately half of the operators relied exclusively on fluoroscopy without any intra-procedural imaging/mapping. Additional ablation lesions beyond PVI were common, with one-third employing standardized PVI+ protocols in persistent AF, most frequently posterior wall isolation. General anaesthesia and deep sedation were used in equal proportions. CONCLUSION: This EHRA survey demonstrates both rapid implementation and significant heterogeneity in PFA use across Europe. Standardized protocols and prospective studies are needed to define best practices.
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Bergonti et al. (2025) conducted a cross-sectional in Atrial fibrillation ablation practices (n=216). Pulsed field ablation (PFA) practice patterns was evaluated on Proportion of first atrial fibrillation ablation procedures using PFA. Pulsed field ablation is now used in 49% of first atrial fibrillation ablation procedures across surveyed centers, driven primarily by time efficiency, though significant heterogeneity in workflows remains.
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