Arrhythmias & electrophysiology
Impact of Lesion Delivery and Irrigation Rates on Neurovascular Events With Pulsed Field Ablation (PFA) for Atrial Fibrillation
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
Methodological detailsvoluntarily reported complaint data
- Voluntarily reported complaint data
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 | Group II4cc, Group II30cc: 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 | Group I: not reported in the abstract |
| 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.
Summarised from the published abstract; every number is checked against it