Pulsed Field Ablation Is Associated With Favorable Outcomes After Atrial Fibrillation Ablation: Insights From the Polish National Ablation Registry (POL‐AR)

Background The Polish National Ablation Registry (POL‐AR), mandatory for all centers performing catheter ablation and integrated with National Health Fund data, enables prospective analysis of a nationwide cohort with complete inclusion of all consecutive patients. Objective We aimed to assess real‐world safety profiles and clinical outcomes of atrial fibrillation (AF) ablation modalities—radiofrequency (RF), cryoballoon (CRYO), and pulsed‐field ablation (PFA)—and to report the first‐year PFA experience in Poland. Methods All AF ablations in 2023 were prospectively analyzed in POL‐AR and cross‐referenced with National Health Fund data. Only centers with complete reporting were included. Patients were grouped by modality. Major complications, unplanned hospitalizations, cardioversions, repeat ablations, and deaths were assessed at 1 year. Multivariate analysis identified independent predictors of outcomes. Results Twenty‐eight centers reported 3430 patients (CRYO: 2125; RF: 1098; PFA: 207). Procedure time was longest for RF (median 120 min) versus CRYO (75 min) and PFA (65 min); ( p < 0.001). No major complications occurred with PFA. Phrenic nerve injury persisted in 1.51% of CRYO, 0.09% of RF, and 0% of PFA patients ( p < 0.001). Pericardial effusion was more frequent after RF (0.91% vs. 0.34% for CRYO + PFA; p = 0.032). Overall complication rates were lowest with PFA (0% vs. RF: 2.19%, CRYO: 2.59%). PFA patients required fewer cardioversions during follow‐up ( p = 0.017). Predictors of poor outcome included age, female sex, left atrium (LA) size, hypertension, and hypertrophic cardiomyopathy (HCM). Favorable outcome was independently associated with higher left ventricular ejection fraction (LVEF), paroxysmal AF, and PFA use (HR 0.70, p = 0.04). Conclusion In the POL‐AR registry, PFA was independently associated with favorable outcomes after AF ablation.