CA PFA resulted in a lower risk of AF recurrence compared to RF ablation, with aOR of 0.50, although not statistically significant (p = 0.081).
Does circular array pulsed field ablation reduce arrhythmia recurrence and improve procedural outcomes compared to radiofrequency ablation in patients undergoing de novo atrial fibrillation ablation?
Circular array pulsed field ablation is safe, significantly reduces procedure times, and is at least as effective as radiofrequency ablation for de novo atrial fibrillation at 1 year.
ABSTRACT Introduction The circular array (CA) pulsed field ablation (PFA) system is the first FDA‐approved PFA technology for atrial fibrillation (AF), but real‐world long‐term outcome data remain limited. Objective To compare 1‐year procedural outcomes and arrhythmia recurrence following CA PFA versus clinically matched radiofrequency (RF) ablation. Methods In this prospective single‐center study, 36 consecutive patients underwent de novo AF ablation with the CA catheter and were matched 1:1 to RF controls by age, sex, left atrial size, body mass index, ejection fraction, and AF type. A previously described lesion optimization strategy with pole 5 anchoring was applied in all PFA cases. The primary endpoint was a composite of AF recurrence, antiarrhythmic use, cardioversion beyond the blanking period, or repeat ablation at 1 year. Results Baseline characteristics were similar between groups. Procedure and left atrial dwell times were significantly shorter with CA PFA (124 vs. 179 min; 72 vs. 115 min; both p < 0.001). No complications occurred in the PFA group, compared with two access‐site hematomas in RF. The composite endpoint occurred less often with PFA (22% vs. 36%, p = 0.195). In multivariable analysis, PFA was associated with a lower risk of recurrence (aOR: 0.50, p = 0.081). Conclusions CA PFA, performed with lesion optimization techniques, was safe, efficient, and at least as effective as RF ablation at 1 year. This study represents the first controlled, real‐world comparison of long‐term outcomes between CA PFA and RF ablation.
Beccarino et al. (2026) studied this question. CA PFA resulted in a lower risk of AF recurrence compared to RF ablation, with aOR of 0.50, although not statistically significant (p = 0.081).