Pulsed-field ablation for atrial fibrillation was associated with a 1.4% incidence of new-onset migraine, with BMI identified as an independent predictor (OR 1.402; 95% CI 1.002–1.987; P=0.031).
Cohort (n=2,148)
Yes
Does pulsed-field ablation cause new-onset migraine or exacerbate pre-existent migraine in patients with atrial fibrillation?
New-onset migraine is an uncommon complication following pulsed-field ablation for atrial fibrillation, occurring in 1.4% of patients, with higher BMI being an independent predictor.
ABSTRACT Background New‐onset migraine or exacerbation of pre‐existent migraine has been reported following catheter ablation for atrial fibrillation (AF). We assessed the incidence of migraine following pulsed‐field ablation (PFA). Methods Consecutive AF patients undergoing PFA using either Farawave or Pulse Select or Sphere 9 catheter systems were included in this multicenter study and prospectively followed up for new migraine or an increase in the severity of the pre‐existent headache. Migraine was labeled as “new onset” if the condition was diagnosed for the first time after the index ablation without any previous history, recent or remote. Anti‐arrhythmic drugs and oral anticoagulation were prescribed for 2 months after the procedure. Results A total of 2148 AF patients undergoing PFA procedures (Farawave: 1477; Pulse Select: 369; and Sphere 9: 392) at the participating centers were included in the analysis. A history of migraine was present in 32 (1.48%) patients, of which 6(18.75%) reported an increase in frequency of migraine in the immediate post‐ablation period. New‐onset migraine was diagnosed in 31 (1.4%) post‐PFA patients. Of these 31 patients, 25 (80.6%) underwent PFA using the Farapulse system, Sphere 9 in 5 (16.12%), and Pulse Select in 1 (3.22%) patient. The incidence of new‐onset migraine was comparable between different systems; 1.69% (95% CI 1.10%−2.49%), 1.65% (95% CI 0.54%−3.82%), and 0.27% (95% CI 0.01%−1.50%) for Farapulse, Sphere 9, and Pulse Select, respectively. Mean duration of onset was 3.08 ± 0.67 days post‐procedure. In the multivariable regression analysis, BMI was found to be the only predictor of new‐onset migraine (OR = 1.402; 95% CI 1.002–1.987; p ‐value = 0.031). Conclusion New‐onset migraine was observed to be uncommon in patients undergoing PFA. Although the incidence rate was comparable among the three platforms analyzed, the Farawave system showed a higher trend. Of note, BMI was an independent predictor of new migraine.
Mohanty et al. (2026) conducted a cohort in Atrial Fibrillation (n=2,148). Pulsed-field ablation was evaluated on New-onset migraine. Pulsed-field ablation for atrial fibrillation was associated with a 1.4% incidence of new-onset migraine, with BMI identified as an independent predictor (OR 1.402; 95% CI 1.002–1.987; P=0.031).