Related Experiment Video
Updated: Jun 26, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Atrial fibrillation ablation energy source transition and adjunctive lesion set utilization after commercial release
James V Freeman1, Nihar R Desai1, Zhen Tan2
1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut.
Background:
Trial data have demonstrated that the safety and effectiveness of pulsed field ablation (PFA) for atrial fibrillation (AF) is non-inferior to radiofrequency (RF) and cryoballoon (CB). However, comparative real-world data on energy source utilization remain limited.
Objective:
To compare utilization, baseline characteristics, procedural characteristics, and acute safety of AF ablation with PFA, RF, CB, and combinations of these energies performed between January 2024 and March 2025.
Methods:
We used multivariable logistic regression models to compare the risk of any adverse event and major adverse events of AF ablations reported to the National Cardiovascular Data Registry AFib Ablation Registry.
Results:
At 158 United States sites, the use of PFA and PFA + RF increased from 0% to 60% and 15%, respectively, whereas the utilization of RF, CB, and RF + CB decreased from 72%, 16%, and 12% to 22%, 2%, and 1%, respectively. The median site monthly volume of AF ablations increased by approximately 50%. Baseline characteristics were similar across energy sources. PFA was associated with shorter procedures and marked changes in the adjunctive lesion utilization, with an increase in left atrial roof/floor/posterior wall ablation and a decrease in cavotricuspid isthmus ablation. There were no differences in the adjusted risk of any adverse event or major adverse event.
Conclusion:
Over the first 15 months since the United States commercial release of PFA, there was an almost complete transition from RF, CB, and RF + CB to PFA and PFA + RF. This was associated with a decrease in procedure times and a 50% increase in procedure volumes. Baseline characteristics and acute procedural safety were similar across energy sources.
