Pulsed-Field Ablation for Atrial Fibrillation with an Extended Protocol: the Extended PFA Dose Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial Fibrillation (n=240). Intervention: Extended pulsed-field ablation (PFA) protocol vs. Standard PFA protocol (8 applications per pulmonary vein). Primary outcome: Freedom from atrial arrhythmia recurrence at 12 months after a 60-day blanking period (p=0.433).

Q: What does this research mean for the field?

An extended protocol for pulsed-field ablation can be utilized in the treatment of atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Corinne Isenegger; Alexander Breitenstein; Niklas Stauffer; Pascal Koepfli; David Siemer; Fabian Jordan; Sven Knecht; Philipp Krisai; Gian Voellmin; Leon Scharf; Jeanne du Fay de Lavallaz; Behnam Subin; Reto Stump; David Spreen; Felix Mahfoud; Christian Sticherling; Michael Kühne; Patrick Badertscher

doi:10.1093/europace/euag253

Key result

Extended pulsed-field ablation protocol fails to improve 12-month arrhythmia-free survival over standard dosing.

P=0.433
n=240

Graphical abstract published by EP Europace — Graphical abstract · Published by EP Europace · CC BY

Why the study?

Key procedural aspects of pulsed-field ablation for atrial fibrillation, including the optimal number of applications per pulmonary vein, remain poorly defined and whether increasing lesion dose improves outcomes is unknown.

Does an extended pulsed-field ablation dosing protocol (12 applications per pulmonary vein) improve freedom from atrial arrhythmia recurrence compared to a standard protocol (8 applications) in patients with atrial fibrillation?

Key Points

To compare the procedural characteristics, safety, and clinical efficacy of an extended pulsed-field ablation dosing protocol against the standard protocol for pulmonary vein isolation.
Analyzed consecutive patients with paroxysmal or persistent atrial fibrillation undergoing pulsed-field ablation across two centers between January 2022 and November 2024.
Compared a standard protocol of eight applications per pulmonary vein to an extended protocol of 12 applications using a pentaspline catheter across 240 patients after 1:2 propensity score matching (80 extended vs. 160 standard).
Evaluated arrhythmia-free survival at 12 months after a 60-day blanking period, alongside procedural times, myocardial injury biomarkers, antral scar area, and complications over a median follow-up of 315 days.
Arrhythmia-free survival at 12 months did not differ significantly between the extended and standard protocols (79% vs. 73%, P = 0.433).
The extended protocol produced higher post-procedural hs-cTnT levels (1789 [1330–2468] vs. 1513 [1027–2015] ng/L, P = 0.008) and a larger total antral scar area (12 [10–12] vs. 8 [7–9] cm 2 , P = 0.015).
Complication rates were 4% in the extended group versus 1% in the standard group (P = 0.337), including two cases of pericardial tamponade and one case of haemolysis with extended dosing.

Study Design

Type

Cohort (n=240)

Multicenter

Yes

Structured PICO

Does an extended pulsed-field ablation dosing protocol (12 applications per pulmonary vein) improve freedom from atrial arrhythmia recurrence compared to a standard protocol (8 applications) in patients with atrial fibrillation?

P

Population

240 propensity-matched patients (median age 68, 31% female) with paroxysmal or persistent atrial fibrillation undergoing index pulmonary vein isolation, followed for a median of 315 days.

I

Intervention

Extended pulsed-field ablation (PFA) dosing protocol (12 applications per pulmonary vein, using FARAPULSE pentaspline catheter)

C

Comparator

Standard pulsed-field ablation (PFA) dosing protocol (8 applications per pulmonary vein)

O

Outcome

Freedom from atrial arrhythmia recurrence at 12 months after a 60-day blanking period

Main Result

Absolute Event Rate: 79% vs 73%

p-value: p=0.433

Limitations

Non-randomized design
Moderate sample size
Potential residual confounding despite propensity matching
No systematic screening for haemolysis
Residual confounding related to operator experience and learning curve effects
Findings may not be generalizable to other PFA platforms
non-randomized design
moderate sample size
potential residual confounding despite propensity matching
no systematic screening for haemolysis
findings may not be generalizable to other PFA platforms

Implication

Escalating pulsed-field ablation applications from 8 to 12 per pulmonary vein increases myocardial injury and lesion size but does not improve arrhythmia-free survival, suggesting standard dosing is sufficient.

Abstract

No abstract yet. The journal hasn't published one we can show.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Isenegger et al. (2026) conducted a cohort in Atrial Fibrillation (n=240). Extended pulsed-field ablation (PFA) protocol vs. Standard PFA protocol (8 applications per pulmonary vein) was evaluated on Freedom from atrial arrhythmia recurrence at 12 months after a 60-day blanking period (p=0.433). An extended pulsed-field ablation protocol of 12 applications per pulmonary vein did not significantly improve 12-month arrhythmia-free survival compared to a standard 8-application protocol (79% vs 73%, p=0.433).

synapsesocial.com/papers/6a9bd4726b95aff0620ec2d6 https://doi.org/10.1093/europace/euag253

View Full Paper

Ask AI

Bookmark

Share

Pulsed-Field Ablation for Atrial Fibrillation with an Extended Protocol: the Extended PFA Dose Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Pulsed-Field Ablation for Atrial Fibrillation with an Extended Protocol: the Extended PFA Dose Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More from EP Europace

Keep reading

More related papers

More from EP Europace