Prognostic Impact of Early Recurrence Following Pulsed Field Ablation: A Meta-Analysis

The conventional 3-month blanking period after atrial fibrillation (AF) ablation has been applied irrespective of energy modality. Pulsed field ablation (PFA), a nonthermal technique, may elicit different tissue responses, questioning the appropriateness of this timeframe. We performed a meta-analysis to evaluate whether early recurrence of atrial tachyarrhythmia (ERAT) after PFA predicts late recurrence (LRAT) and to assess the duration of the traditional blanking period.

We systematically searched PubMed, Embase, and Cochrane Library through April 2025 for studies reporting ERAT and LRAT following PFA for AF.

Nine studies (N = 3384) met the inclusion criteria. ERAT within 3 months post-PFA occurred in 14% of patients. Patients with ERAT had significantly higher odds of LRAT (pooled OR: 8.66; 95% CI: 5.69-13.18; p < 0.001). Importantly, ERAT in the first month was not predictive of LRAT (OR: 1.30; p = 0.52), whereas ERAT in Months 2-3 strongly predicted LRAT.

ERAT after PFA is a strong predictor of LRAT, especially if occurring beyond the first month. These findings challenge the traditional 3-month blanking period for PFA and support shortening or individualizing this window. A tailored post-PFA surveillance approach focusing on arrhythmias beyond 1 month may improve timely interventions and long-term outcomes. Prospective studies are needed to refine blanking period duration for PFA.