Pulsed Field Ablation as First-Line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Early ablation is increasingly recognized for preventing atrial fibrillation (AF) progression.
• Clinical practice now supports ablation without prior antiarrhythmic drug (AAD) failure.
• Evidence on pulsed field ablation (PFA) as a first-line therapy is limited.

Purpose of the Study:

• To evaluate real-world outcomes of PFA in AF patients.
• To compare PFA effectiveness in first-line therapy versus after AAD failure.
• To assess PFA's role in current AF management strategies.

Main Methods:

• Analysis of the European Real World Outcomes with Pulsed Field Ablation registry.
• Comparison of patients receiving PFA as first-line therapy versus those with prior AAD use.
• Exclusion of patients with incomplete AAD history, long-standing persistent AF, or prior ablation.

Main Results:

• 1091 patients met inclusion criteria; 589 received PFA first-line, 502 had prior AAD use.
• First-line PFA group had more paroxysmal AF and PVI-only procedures.
• One-year freedom from AF/atrial tachycardia recurrence was similar: 78% (first-line) vs. 74% (prior AAD).

Conclusions:

• Real-world data indicates PFA achieves comparable 1-year success rates for AF/atrial tachycardia recurrence.
• PFA demonstrates similar efficacy as both a first-line treatment and after prior AAD therapy.
• These findings support the expanding role of PFA in early AF management.