Reduced Early Recurrence After Pulmonary Vein Isolation With Pulsed Field Ablation Compared to Thermal Ablation

Early recurrence of atrial tachyarrhythmia (ERAT) during the 90-day blanking period after pulmonary vein isolation (PVI) remains a challenge and has been associated with increased healthcare utilization and patient anxiety. Comparative data on ERAT incidence across energy modalities, including pulsed field ablation (PFA), high-power short-duration (HPSD), very high-power short-duration (vHPSD), and cryoballoon ablation, are limited.

To assess and compare the incidence and timing of ERAT following PVI using four ablation technologies.

In this single-center observational cohort study, 671 consecutive patients undergoing first-time PVI were screened. One hundred consecutive patients undergoing cryoballoon ablation were included as reference group, and three additional groups (HPSD, vHPSD, PFA; each n = 100) were propensity score-matched based on age, sex, BMI, and AF type. ERAT was defined as a clinically detected episode of atrial fibrillation or atrial tachycardia lasting >30 s within 90 days after PVI, documented by 12-lead ECG or Holter monitoring during scheduled or clinically indicated rhythm surveillance. Procedural characteristics, procedural success, and safety were evaluated.

Among 400 matched patients, PFA was associated with a significantly lower ERAT incidence compared to thermal ablation (3% vs. 15%-19%, p < 0.01). In PFA patients, ERAT occurred exclusively between Days 31 and 90. Thermal energy groups showed higher rates of early recurrences, often requiring clinical interventions, including hospitalizations and cardioversions. Multivariate analysis did not identify any additional clinical predictors of ERAT.

PFA was associated with a significantly lower rate of early arrhythmias, which may be related to differences in tissue injury mechanisms. These findings suggest PFA may offer a clinical advantage in reducing clinically relevant ERAT and the associated healthcare burden after PVI.