Procedural Time Predictability with Pulsed Field Ablation Compared with Thermal Ablation: Real-World Evidence in Paroxysmal and Persistent Atrial Fibrillation.

Q: What are the key findings of this study?

Pulsed field ablation resulted in significantly shorter and more predictable procedural times compared to cryoballoon ablation in de novo procedures (58.5 vs 75.7 minutes; P<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Paroxysmal and persistent atrial fibrillation (n=1845). Intervention: Pulsed field ablation (PFA) vs. Thermal ablation (radiofrequency and cryoablation). Primary outcome: Mean procedural time in de novo ablation (PFA-PVI vs cryoballoon PVI, in minutes) (p=<0.001).

Q: What does this research mean for the field?

Pulsed field ablation delivers significantly shorter and more predictable procedural times compared with thermal ablation in both de novo and redo atrial fibrillation ablation procedures. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether pulsed field ablation improves procedural time predictability compared with thermal ablation methods in real-world de novo and redo atrial fibrillation procedures.

Ahmad Awada; Giampaolo Vetta; Pablo E. Bretos-Azcona; Antonio Sorgente; Juan Sieira; Erwin Ströker; Rami Daya; Ingrid Overeinder; Luigi Pannone; Ludovica Carmagnola; Paul A. Calburean; Luca Canovi; Ivan Eltsov; Tommaso Sattin; Domenico Laviola; Francesco De Vuono; Alvise Del Monte; Lorenzo Marcon; Edona Berisha; Gezim Bala; Andrea Sarkozy; Carlo de Asmundis; Chierchia Gian-Battista; Domenico Giovanni Della Rocca

doi:10.1016/j.hroo.2026.10.002

Key result

Pulsed field ablation linked to ~17-minute shorter procedure times than cryoballoon in de novo ablation.

P<0.001
n=1,845

Why the study?

Efficient use of EP laboratory resources requires accurate prediction of procedural durations for AF ablation, and it is unclear if PFA improves procedural time predictability compared with thermal ablation.

Does pulsed field ablation improve procedural time predictability and reduce EP lab time compared with thermal ablation in real-world de novo and redo atrial fibrillation ablation?

Key Points

To determine whether pulsed field ablation improves procedural time predictability compared with thermal ablation methods in real-world de novo and redo atrial fibrillation procedures.
Retrospective analysis of N=1845 procedures, including 1730 de novo cases (599 PFA pulmonary vein isolation [PVI], 531 PFA-PVI plus posterior wall isolation [PWI], and 600 cryoballoon PVI) and 115 redo cases (69 PFA and 46 radiofrequency [RF]).
Procedural duration variability was evaluated using Levene, Brown–Forsythe, and trimmed-mean tests, with multivariable linear regression on log-transformed duration to identify predictors of electrophysiology (EP) lab time.
In de novo ablations, mean procedural time was significantly shorter for PFA-PVI (58.5 ± 23.4 min) compared with PFA-PVI+PWI (71.6 ± 31.1 min) and cryoballoon PVI (75.7 ± 39.5 min; p<0.001), with corresponding EP lab times of 94.5 ± 28.7, 110.1 ± 37.2, and 109.3 ± 41.7 min (p<0.001).
In redo procedures, PFA required significantly less EP lab time than RF ablation (102.5 ± 22.0 vs. 156.8 ± 49.5 min; p<0.001).
PFA demonstrated significantly lower procedural time variance across all statistical tests (p<0.001) and independently predicted reduced EP lab time in multivariable regression for both de novo (β = –0.142, p<0.001) and redo cases (β = –0.340, p<0.001).

Study Design

Type

Observational (n=1,845)

Structured PICO

Does pulsed field ablation improve procedural time predictability and reduce EP lab time compared with thermal ablation in real-world de novo and redo atrial fibrillation ablation?

P

Population

1,845 real-world de novo and redo atrial fibrillation ablation procedures to evaluate procedural time predictability.

E

Exposure

Pulsed field ablation (PFA) for pulmonary vein isolation (PVI) alone or with posterior wall isolation (PWI) in de novo procedures, and PFA in redo procedures

C

Comparator

Thermal ablation, specifically cryoballoon PVI for de novo procedures and radiofrequency (RF) ablation for redo procedures

O

Outcome

Procedural time predictability (variability assessed using Levene, Brown-Forsythe, and trimmed-mean tests) and EP lab time

Main Result

Absolute Event Rate: 58.5% vs 75.7%

p-value: p=<0.001

Implication

Pulsed field ablation for atrial fibrillation yields significantly shorter and more predictable procedural times compared to thermal ablation, potentially improving electrophysiology laboratory workflow and efficiency.

Abstract

Background Efficient use of electrophysiology (EP) laboratory resources is enhanced by accurate prediction of procedural durations for atrial fibrillation (AF) ablation. The availability of devices with reproducible procedural durability further supports this process, improving scheduling efficiency and overall resource utilization. Objective This study evaluated whether pulsed field ablation (PFA) improves procedural time predictability compared with thermal ablation (radiofrequency (RF) and cryoablation (CRYO)) in real-world de novo and redo AF ablation. Methods Retrospective analysis comparing procedural variability using Levene, Brown–Forsythe, and trimmed-mean tests. Determinants of EP lab time were identified via multivariable regression with log-transformed time as the dependent variable. Results A total of 1845 procedures were analyzed, comprising 1730 de novo cases (599 PFA-Pulmonary Vein Isolation [PVI], 531 PFA-PVI+Posterior Wall Isolation [PWI], 600 CRYO-PVI) and 115 redo cases (69 PFA, 46 RF). In de-novo procedures, mean procedural time was shorter with PFA-PVI (58.5 ± 23.4 min) than with PFA-PVI+PWI (71.6 ± 31.1 min) and cryoballoon PVI (75.7 ± 39.5 min; p<0.001). Corresponding EP lab times were 94.5 ± 28.7, 110.1 ± 37.2, and 109.3 ± 41.7 min (p<0.001). In redo procedures, PFA required significantly less EP lab time than RF (102.5 ± 22.0 vs. 156.8 ± 49.5 min; p<0.001). Across all variance tests, PFA demonstrated significantly lower variability in both de novo and redo cases (p<0.001). Multivariable analysis confirmed PFA reduced EP lab time in de novo (β = –0.142) and redo procedures (β =-0.340; both p<0.001).Factors associated with longer procedural times included PWI, cavotricuspid isthmus ablation, presence of cardiac implantable electronic devices, and prior cardiac surgery. Conclusions PFA delivers more predictable procedural times than thermal ablation. Integrating procedural time predictability into ablation modality selection may enhance workflow efficiency, optimize EP lab scheduling, and improve overall procedural throughput.

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Cite This Study

Awada et al. (2026) conducted an observational in Paroxysmal and persistent atrial fibrillation (n=1,845). Pulsed field ablation (PFA) vs. Thermal ablation (radiofrequency and cryoablation) was evaluated on Mean procedural time in de novo ablation (PFA-PVI vs cryoballoon PVI, in minutes) (p=<0.001). Pulsed field ablation resulted in significantly shorter and more predictable procedural times compared to cryoballoon ablation in de novo procedures (58.5 vs 75.7 minutes; P<0.001).

synapsesocial.com/papers/6ad00213cdb4bd3714987c9d https://doi.org/10.1016/j.hroo.2026.10.002

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Procedural Time Predictability with Pulsed Field Ablation Compared with Thermal Ablation: Real-World Evidence in Paroxysmal and Persistent Atrial Fibrillation.

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

Procedural Time Predictability with Pulsed Field Ablation Compared with Thermal Ablation: Real-World Evidence in Paroxysmal and Persistent Atrial Fibrillation.

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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