Pulsed Field Ablation Is Associated With Fewer Post-Procedural Pericardial Inflammatory Symptoms Compared With...

Acute pericarditis is an uncommon complication of thermal atrial fibrillation (AF) ablation, whereas milder pericardial inflammatory symptoms, typically pleuritic or positional chest pain, are more common and negatively affect post-procedural recovery. Pulsed field ablation (PFA), a non-thermal modality with tissue-selective properties, may reduce collateral pericardial injury. We compared post-procedural pericardial inflammatory symptoms and recovery after AF ablation using PFA vs. radiofrequency ablation (RFA).

This single-center observational study with prospective data collection included 150 patients undergoing catheter ablation for paroxysmal or persistent AF using focal PFA (n = 75) or RFA (n = 75). Patients were identified from the procedural workflow during the study period. Post-procedural pericardial inflammatory symptoms, chest pain severity (5-point scale), anti-inflammatory therapy use, length of hospital stay, and biomarkers of inflammation (CRP) and myocardial injury (hs-TnT) were assessed during hospitalization and structured post-discharge follow-up.

Baseline characteristics were similar between groups. Post-procedural chest pain occurred more frequently after RFA than PFA (32% vs. 5.3%, p < 0.001), despite a significantly greater proportion of patients in the PFA group receiving lesion sets beyond pulmonary vein isolation (94.7% vs. 73.3%, p < 0.001). Anti-inflammatory therapy was prescribed more frequently after RFA (20% vs. 2.7%, p = 0.001), and hospital length of stay was longer [2 (1-2) vs. 1(1-1) days, p = 0.03). Procedure duration was shorter with PFA (86 ± 36 vs. 122 ± 55 min, p < 0.001). Median hs-TnT levels were higher after PFA [1288 (865-2137) vs. 1001 (652-1368] ng/L, p = 0.01), whereas CRP levels were similar [10.4 (4.9-23.3) vs. 10.5 (6.9-27.3) mg/L; p = 0.38].

PFA was associated with fewer post-procedural pericardial inflammatory symptoms, reduced need for anti-inflammatory therapy, and faster recovery compared with RFA. These findings suggest reduced pericardial irritation and improved patient-centered recovery after AF ablation.