Arrhythmias & electrophysiology
Optimizing Pulsed Field Ablation: Results From a 1,000-Patient Cohort
Authors' conclusion
In this large cohort, PFA demonstrated high efficacy with short procedure times, low complication rates, and favorable long-term outcomes. Workflow refinements improved safety and PVI durability, underscoring PFA's role for standardized and safe AF ablation.
Study context
- Population
- Consecutive atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) using the pentaspline pulsed field ablation (PFA) catheter between April 2021 and May 2024, excluding ablation beyond PVIpatients included
- Participants
- 1,000 patients
- Comparison
- Sequential workflow refinements, including the transition from 8 applications to the 10-application "olive" strategy
Methodological detailsconsecutive AF patients
- Consecutive AF patients
Main finding
As reported in the abstract
PVI achieved
Median procedure time
30 minutes
Q1-Q3: 25–40 minutes
Further findings
| Outcome | Paroxysmal AF | Persistent AF | Conventional approach | Olive strategy | P value | |
|---|---|---|---|---|---|---|
| Arrhythmia-free survival · One-year · higher in paroxysmal AF | 83.8% | 66.6% | Not reported in the abstract | Not reported in the abstract | P < 0.001 | conventional approach, olive strategy: not reported in the abstract |
| PVI durability by approach · increased with the olive strategy | Not reported in the abstract | Not reported in the abstract | 78.7% | 91.6% | P < 0.001 | paroxysmal AF, persistent AF: not reported in the abstract |
- Arrhythmia-free survival — overall
- 76.6%
- Arrhythmia-free survival: Median follow-up time was 454 days (Q1-Q3: 370-631 days)
Durable PVI at repeat procedures
- Veins with durable PVI across 173 repeat procedures
- 82% (n = 562 of 685)
PVI durability by approach
- PVI durability increased from 78.7% with the conventional approach to 91.6% with the olive strategy, while long-term outcomes remained unchanged
Safety
Complications
- Major complication rate
- 0.5%
- Total complication rate (primarily access site related)
- 2.1%
Tamponade, before vs after workflow refinements
- Before refinements
- 0.8% (n = 2 of 260)
- After refinements
- 0% (n = 0 of 740)
- Trend toward reduction (P = 0.067)
Procedure-related bradycardia, before vs after workflow refinements
- Before refinements
- 49.3%
- After refinements
- 5%
- P < 0.001
Original publication
Optimizing Pulsed Field Ablation: Results From a 1,000-Patient Cohort. JACC Clin Electrophysiol. Published 22 July 2026. doi:10.
Summarised from the published abstract; every number is checked against it