Pulsed-field Ablation for Paroxysmal and Persistent Atrial Fibrillation: A Single-center Experience

Atrial fibrillation (AF) increases morbidity and mortality. Traditional catheter ablation techniques have limitations. Pulsed-field ablation (PFA) is a new nonthermal ablation method aiming to eliminate arrhythmogenic tissue while minimizing collateral damage. The study reported the initial experience of the prince sultan cardiac center with PFA and the learning curve.

This retrospective study included 33 patients with paroxysmal or persistent AF who underwent ablation with the PFA technique from 2022 to 2023. The study outcomes included short-term and follow-up complications and AF recurrence.

The mean age was 48.52 ± 13.97 years, and 24 patients were males (72.73%). Hypertension was the most common comorbidity encountered in 11 patients (33.33%). Thirteen patients (39.39%) were on antiarrhythmic medications, and 26 (78.79%) were on nonvitamin K-dependent oral anticoagulation. The most common indication was symptomatic paroxysmal AF (n = 28; 84.85%). The preprocedural left atrial diameter was 41.82 ± 14.78 mm, and the ejection fraction was 51.36% ±8.41%. The left atrial ablation time was 45.38 ± 17.96 min, the fluoroscopy time was 33.45 ± 15.60 min, and the procedure time was 77.55 ± 19.73 min. No complications were reported postprocedurally or at 3 or 6 months. One patient had recurrent AF; one developed atrial flutter after 9 months and underwent ablation.

Pulmonary vein isolation using PFA for paroxysmal and persistent AF might be a safe and effective procedure. Future long-term studies comparing PFA with other ablation techniques are recommended.