Arrhythmias & electrophysiology
Incidence and risk factors of acute blood pressure drops during circular-array pulsed-field ablation for pulmonary vein isolation
Authors' conclusion
Acute BP drops are common during circular-array PFA-PVI and occur predominantly during the first PV treatment.
Study context
- Population
- Patients who underwent PFA-PVI using a circular-array system (PulseSelect, Medtronic Inc)consecutive patients, 1797 applications
- Participants
- 50 patients
- Exposure
- 4 predefined sequencing protocols, categorized according to the first targeted pulmonary vein (PV)
- Outcome
- BP drops (>40 mm Hg decrease or absolute value of <60 mm Hg)
- Follow-up
- Immediately after each application
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
Applications with blood pressure (BP) drops (of 1797 applications)
205 applications
11%
Patients with at least 1 episode
38 of 50 patients
76%
Observational data: associations, not effects.
Further findings
Coughing
- Coughing: P < .001
Severe BP drops (requiring intervention)
- Applications with severe BP drops
- 30 applications (2%)
- Patients with severe BP drops
- 16 patients (32%)
- Share of severe BP drops clustered in the left superior PV-first protocol
- 53%
Systolic BP change across the sequence
- Systolic BP decreased after each application, with attenuation in magnitude as the sequence progressed
- P < 0.001
Risk factors (multivariable models)
- Earlier application order and distal-segment applications independently associated with BP drops
- Severe BP drops independently associated with left PV targeting
Risk by sequence block (sequence-stratified models)
- First PV treated (applications 1-9) carried the highest risk, with a stepwise decline in risk across subsequent blocks
Original publication
Incidence and risk factors of acute blood pressure drops during circular-array pulsed-field ablation for pulmonary vein isolation. Heart Rhythm. Published 20 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it