Comparative Clinical and Procedural Outcomes Among Three Pulsed Field Ablation Systems for Atrial Fibrillation: A Prospective Real-World Study

Pulsed Field Ablation (PFA) is a non-thermal ablation technology for atrial fibrillation. Several PFA systems are available, with distinct catheter designs and energy delivery protocols. Direct comparisons between PFA systems remain limited. This study compared the procedural characteristics, safety, and efficacy of three contemporary PFA technologies in routine clinical practice. Consecutive patients undergoing their first pulmonary vein isolation (PVI) using the circular multielectrode array catheter (CMAC)(PulseSelectTM), the variable-loop circular catheter (VLCC)(VaripulseTM) or the lattice-tip catheter (LTC)(AfferaTM) were prospectively included. Freedom from any atrial arrhythmia (AA) was evaluated using 12-lead electrocardiography and 24-hour Holter at 3, 6 and 12 months, followed by routine clinical follow-up. A total of 198 patients (CMAC:91, VLCC:50, LTC: 57) were included. Acute PVI was achieved in all patients (median age, 68 [61.0, 76.0] years; 127 male (64.1%); 97 paroxysmal (49.0%)). The procedure and ablation times were longest in the LTC group. During a mean follow-up of 352.4±207.2 days, the estimated 12-month freedom from AA recurrence beyond the 8-week blanking period was comparable among the CMAC, VLCC, and LTC groups (76.9%, 71.6%, and 78.8%; log-rank p=0.72). In adjusted multivariable Cox regression, PFA system choice was not associated with AA recurrence (LTC vs. CMAC: HR 0.77, 95% CI 0.39-1.52, p=0.45; VLCC vs. CMAC: HR 1.16, 95% CI 0.58-2.34, p=0.67). One major complication (0.51%, ischemic stroke (CMAC)) occurred. In this prospective real-world study, PVI with the CMAC, VLCC, and LTC showed comparable efficacy and safety outcomes, while procedural profiles differed.