Real-world one-year effectiveness of three pulsed field ablation systems for atrial fibrillation

Background In Japan, three pulsed field ablation (PFA) systems—Varipulse [VP], PulseSelect [PS], and Farapulse [FP] —are currently available for atrial fibrillation (AF) ablation; however, direct comparative outcome data are limited. Purpose To compare 1-year arrhythmia-free survival among Varipulse, PulseSelect, and Farapulse in a real-world cohort. Methods We retrospectively analysed 600 consecutive patients who underwent first-session catheter ablation for AF using PFA at our center between July 2024 and January 2026. All patients underwent pulmonary vein isolation (PVI) only, with no additional extra-pulmonary vein ablation. In all cases, a post-ablation map was created using a high-density mapping catheter after PVI. Follow-up included 12-lead ECG at 1, 3, 6, and 12 months, and extended Holter monitoring at the treating physician’s discretion. One-year arrhythmia-free survival was evaluated separately for paroxysmal and persistent AF (Figure 1 and Figure 2). Results Mean age was 71 years, 64% were male, and mean body mass index was 24 kg/m². Varipulse (VP) was used in 85 patients, PulseSelect (PS) in 159, and Farapulse (FP) in 356. AF type differed across groups: VP 100% paroxysmal; PS 38% paroxysmal and 62% persistent; FP 79% paroxysmal and 21% persistent. Mean left ventricular ejection fraction and left atrial diameter were 63% and 39 mm (VP), 60% and 43 mm (PS), and 61% and 40 mm (FP), respectively. Mean procedure time and fluoroscopy time were 70 min and 14 min (VP), 66 min and 20 min (PS), and 59 min and 18 min (FP), respectively. In paroxysmal AF, 1-year arrhythmia-free survival was 85.7% (VP), 92.2% (PS), and 88.1% (FP), with no significant difference (p=0.71; Figure 1). In persistent AF, 1-year arrhythmia-free survival was 72.7% (PS) and 80.1% (FP), with no significant difference (p=0.21; Figure 2). Conclusion In this single-center, real-world cohort, three large-footprint regional PFA systems demonstrated similar 1-year arrhythmia-free outcomes, both in paroxysmal and persistent AF.Figure1.Paroxysmal AFFigure2.