Advancing AF ablation: a real-world comparison of pulsed field ablation and radiofrequency techniques

BACKGROUND: Atrial fibrillation (AF), the most common sustained arrhythmia, is a growing global concern. Catheter ablation is central to rhythm control. Pulsed field ablation (PFA), a novel non-thermal method for pulmonary vein isolation (PVI), enables myocardial-specific ablation via irreversible electroporation while sparing adjacent tissues. This study compares phased radiofrequency PVAC and the new PFA-based PulseSelect system in terms of procedural efficiency, safety, and short-term efficacy.METHODS: We conducted a retrospective observational study involving 235 patients with paroxysmal or persistent AF undergoing pulmonary vein isolation (PVI) with either PVAC (N.=121) or PulseSelect (N.=114). Primary endpoints included procedural time, fluoroscopy time, and acute procedural success. The secondary endpoint was AF recurrence-free survival at 12 months. Statistical comparisons were performed using t-tests and Chi-square tests. Recurrence-free survival was compared using Kaplan-Meier test.RESULTS: Procedural and fluoroscopy times were significantly reduced in the PulseSelect group compared to PVAC (56.04 vs. 78.09 min; P<0.001 and 12.46 vs. 16.47 min; P<0.001, respectively). Recurrence-free survival at 12 months was higher in the PulseSelect group (79.8% vs. 68.1%; log-rank P=0.029). A low rate of complications were reported across the two groups with only one pseudoaneurysm observed in PFA group, and five cases of pericardial effusion in the PVAC group, managed conservatively.CONCLUSIONS: PulseSelect PFA resulted in shorter procedural times, reduced radiation exposure, and higher short-term efficacy compared to PVAC, with a favorable safety profile. These findings support PFA as a promising alternative to traditional RF-based techniques for AF ablation.