Pulsed Field Ablation for Atrial Fibrillation in Australia: A Large Tertiary Centre Analysis

BACKGROUND: Pulsed field ablation (PFA) is increasingly used for catheter ablation of atrial fibrillation (AF). Limited real-world data exists regarding safety and efficacy of PFA in Australia. METHOD: We conducted a retrospective analysis of consecutive patients undergoing de novo PFA for paroxysmal or persistent AF at a large tertiary centre using a pentaspline catheter (FARAPULSE, Boston Scientific) from 2022 to 2025. Baseline demographics, procedural characteristics, procedural complications, clinical outcomes and repeat procedures were collected. Arrhythmia recurrence was defined as >30 seconds of AF, atrial flutter or atrial tachycardia at follow-up with no blanking period. RESULTS: Overall, 564 consecutive patients (median age 64 years, 35% female) underwent de novo PFA for AF during the study period. Most patients had paroxysmal AF (63%). Pulmonary vein (PV) isolation was performed in 563 of 564 patients; posterior wall (PW) isolation was performed in 41% and superior vena cava ablation in 3%. Median total applications were 58 (interquartile range [IQR] 50-70). Median total procedural time was 63 minutes (IQR 51-76). Major procedural complications occurred in 1.8% (10/564) patients and minor procedural complications occurred in 12.6% (71/564), mostly because of minor vascular access complications (8.2%). Six (6)-month freedom from arrhythmia was 72%; cardioversions were performed in 5.3% and 2.7% had arrhythmia-related hospitalisation. In 35 patients (6.2%) who underwent repeat procedure, PV and PW durability was 45% and 32%, respectively. CONCLUSIONS: PFA for AF is reasonably safe with acceptable clinical outcomes. These real-world data provide clinicians with potential expected clinical outcomes for patients referred for PFA in Australia.