March 31, 2026Heart Rhythm0 citations
Electrogram-guided pulsed field ablation for persistent atrial fibrillation: A prospective cohort study
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Key Result
Electrogram-guided pulsed field ablation improved 12-month freedom from atrial fibrillation or tachycardia compared to anatomical ablation (82.4% vs 65.9%; HR 0.47; 95% CI 0.25-0.87; P=0.017).
Key Points
- This study investigates the efficacy and safety of electrogram-guided pulsed field ablation in persistent atrial fibrillation.
- Prospective cohort study with 3D-Carto mapping and Farawave catheter.
- 85 patients in EGM-guided pulsed field ablation group compared to 85 in anatomical pulmonary vein isolation group.
- Primary endpoints were AF termination and freedom from AF/atrial tachycardia recurrence at 12 months.
- 84.7% of patients in the EGM group experienced intra-procedural AF termination versus 11.8% in the PWI group (p<0.001).
- At 12 months, 82.4% of EGM patients were AF/AT-free compared to 65.9% in the PWI group (log-rank p = 0.017; HR = 0.47, 95% CI 0.25-0.87).
- AF termination during the procedure correlated with higher AF/AT-free survival rates: 84.1% versus 64.8% (log-rank p = 0.007; HR = 0.40, 95% CI 0.21-0.77).
Study Design
Type
Cohort (n=170)
Multicenter
No
Structured PICO
Does EGM-guided PFA improve freedom from AF/AT recurrence compared to anatomical PVI plus PWI in patients with persistent atrial fibrillation?
P
Population
170 patients with persistent atrial fibrillation (PerAF)
I
Intervention
Electrogram (EGM)-guided pulsed field ablation (PFA) including pulmonary vein isolation (PVI), posterior wall isolation (PWI), and target EGM ablation using 3D-Carto mapping combined with the Farawave catheter
C
Comparator
Anatomical PVI plus PWI using the same PFA system
O
Outcome
Freedom from AF/atrial tachycardia (AT) recurrence at 12 months after a single procedure, off anti-arrhythmic drugshard clinical
EGM-guided PFA significantly improved 12-month freedom from AF/AT recurrence compared to anatomical PVI plus PWI in patients with persistent atrial fibrillation.
Main Result
Effect estimate: HR 0.47 (95% CI 0.25-0.87)
Absolute Event Rate: 82.4% vs 65.9%
p-value: p=0.017
Limitations
- Single-center study
- Non-randomized design
Abstract
BACKGROUND Optimal ablation strategies of pulsed field ablation (PFA) in persistent atrial fibrillation (PerAF) remain under investigation. OBJECTIVE This study explores an innovative electrogram(EGM)- guided PFA approach for PerAF ablation. METHODS This prospective cohort study used 3D-Carto mapping combined with the Farawave catheter for ablation. 85 patients with PerAF who underwent EGM-guided PFA pulmonary vein isolation (PVI), posterior wall isolation (PWI) and target EGM ablation were enrolled (EGM group). Another cohort of 85 patients treated with anatomical PVI plus PWI using the same PFA system were also included as the control group (PWI group). The procedure endpoint was AF termination or complete ablation of all target sites. The primary efficacy endpoint was freedom from AF/atrial tachycardia (AT) recurrence at 12 months after a single procedure, off anti-arrhythmic drugs. Safety outcomes included PFA-related adverse events. RESULTS Seventy-two (84.7%) patients in the EGM group experienced intra-procedural AF termination, which was significantly higher than the PWI group (10/85, 11.8%; p<0.001). At 12 months, the primary efficacy outcome (AF/AT-free survival) achieved in 82.4% (70/85) patients in the EGM group versus 65.9% (56/85) in the PWI group (log-rank p = 0.017; HR = 0.47, 95% CI 0.25-0.87). Patients who reached procedural AF termination had a higher rate of AF/AT-free survival of 84.1% versus 64.8% of non-AF termination (log-rank p = 0.007; HR = 0.40, 95% CI 0.21-0.77). The primary safety endpoint occurred in 1 patient (1.2%) with hemolysis in the EGM group. No other PFA-related adverse event was observed. CONCLUSION In this single-center, non-randomized comparative cohort study, EGM-guided PFA demonstrated preliminary efficacy and safety in the ablation of PerAF, suggesting promising prospects as an innovative strategy for PerAF ablation. (ClinicalTrials, NCT06729866, EGM Guided PFA for PerAF).