Arrhythmias & electrophysiologyCohort study
Impact of Lesion Delivery and Irrigation Rates on Neurovascular Events With Pulsed Field Ablation (PFA) for Atrial Fibrillation
- retrospectively extracted from the manufacturer's complaint database
- voluntarily reported complaint data
Authors' conclusion
These data suggest that workflow factors may account for the 10-fold reduction in neurovascular events before vs after the commercial pause, namely by delivering fewer ablations (32.6 to 21.2) and avoiding stacking lesions.
Study context
- Population
- Variable loop circular catheter (VLCC) pulsed field ablation procedures for atrial fibrillation performed within the United States between December 2024 and August 2025Group I (pre-pause) 132 · Post-pause (Group II4cc and Group II30cc) 6,679
- Participants
- 6,811 VLCC procedures
- Exposure
- neurovascular events associated with pre-pause (Group I; 4 mL/min irrigation) and post-pause workflows using 4 mL/min (Group II4cc) and 30 mL/min (Group II30cc) irrigation settings
- Group In = 132
Main finding
As reported in the abstract
Neurovascular event rate, pre-pause vs post-pause
Observational data: associations, not effects.
Further findings
| Outcome | Group I | Group II4cc | Group II30cc | P value |
|---|---|---|---|---|
| Number of ablations | 32.6 ± 11.2 | Not reported in the abstract | Not reported in the abstract | |
| Neurovascular event rate, Group II30cc vs Group II4cc | Not reported in the abstract | 0.39% | 0.22% | P = 0.213 |
| Neurovascular event rate, pulmonary vein isolation-only cohort vs pulmonary vein isolation plus cohort · no difference | P = 0.929 |
- Number of ablations: Group II4cc/II30cc 21.2 ± 7.8
- Neurovascular event rate, pulmonary vein isolation-only cohort vs pulmonary vein isolation plus cohort: pulmonary vein isolation-only cohort 0.28%
- Neurovascular event rate, pulmonary vein isolation-only cohort vs pulmonary vein isolation plus cohort: pulmonary vein isolation plus cohort 0.29%
Original publication
Impact of Lesion Delivery and Irrigation Rates on Neurovascular Events With PFA for Atrial Fibrillation. JACC Clin Electrophysiol. Published 6 February 2026. doi:10.1016/j.jacep.2026.01.025
Summarised from the published abstract; every number is checked against it