Comparison of Two Pulsed Field Ablation Systems for Atrial Fibrillation: One-Year Outcomes From a Multicenter...

While various pulsed field ablation (PFA) systems for atrial fibrillation (AF) ablation have become available in recent years, data comparing long-term efficacy outcomes remain limited.

To compare long-term efficacy outcomes of two commercially available PFA systems to perform pulmonary vein isolation (PVI) for AF in a multicenter clinical setting.

We conducted an international, multicenter, registry study of patients with AF undergoing a first ablation between January 29, 2024, and September 1, 2024. Patients were treated with either the pentaspline catheter or the circular over-the-wire catheter in all centers. Endpoints included time to recurrence of atrial arrhythmias following a 2-month blanking period and repeat ablation outcomes. Factors associated with recurrence were assessed.

A total of 428 patients were included, of whom 231 (54.0%) were treated with the pentaspline catheter. Most patients (84.6%) underwent a PVI-only procedure, with significantly longer procedure and LA dwell times observed in the circular catheter group (p < 0.001). Acute procedural success was achieved in all patients. At 12 months, AF-recurrence was observed in 33.5% of patients overall, with similar rates between groups (pentaspline catheter 34.1% vs. circular catheter 32.8% [log-rank p = 0.93]). A longer time since AF diagnosis and persistent AF were associated with recurrence of AF. Repeat ablation was performed in 14.9% of patients.

In this study, we compared two commercially available PFA systems for primary PVI in AF patients. Both achieved high acute success and similar 12-month AF recurrence rates, indicating comparable efficacy.