Comparison of Two Pulsed Field Ablation Systems for Atrial Fibrillation: One‐Year Outcomes From a Multicenter Registry

ABSTRACT Background While various pulsed field ablation (PFA) systems for atrial fibrillation (AF) ablation have become available in recent years, data comparing long‐term efficacy outcomes remain limited. Purpose To compare long‐term efficacy outcomes of two commercially available PFA systems to perform pulmonary vein isolation (PVI) for AF in a multicenter clinical setting. Methods We conducted an international, multicenter, registry study of patients with AF undergoing a first ablation between January 29, 2024, and September 1, 2024. Patients were treated with either the pentaspline catheter or the circular over‐the‐wire catheter in all centers. Endpoints included time to recurrence of atrial arrhythmias following a 2‐month blanking period and repeat ablation outcomes. Factors associated with recurrence were assessed. Results A total of 428 patients were included, of whom 231 (54.0%) were treated with the pentaspline catheter. Most patients (84.6%) underwent a PVI‐only procedure, with significantly longer procedure and LA dwell times observed in the circular catheter group ( p < 0.001). Acute procedural success was achieved in all patients. At 12 months, AF‐recurrence was observed in 33.5% of patients overall, with similar rates between groups (pentaspline catheter 34.1% vs. circular catheter 32.8% log‐rank p = 0.93). A longer time since AF diagnosis and persistent AF were associated with recurrence of AF. Repeat ablation was performed in 14.9% of patients. Conclusion In this study, we compared two commercially available PFA systems for primary PVI in AF patients. Both achieved high acute success and similar 12‐month AF recurrence rates, indicating comparable efficacy.