Arrhythmias & electrophysiology
Pulmonary Vein Isolation Using Pulsed Field Ablation With vs Without Posterior Wall Isolation in Patients With Symptomatic Persistent Atrial Fibrillation: The PIFPAF-PFA Randomized Clinical Trial
Primary result · Atrial tachyarrhythmia recurrenceResult — go to the resultRelative risk 0.75 95% CI 0.51–1.09Authors' conclusion
In patients with persistent AF, adding PFA-based PWI to PVI did not significantly reduce atrial tachyarrhythmia recurrence lasting 30 seconds or longer compared with PVI alone.
Study context
- Population
- Patients with symptomatic persistent atrial fibrillation (AF)
- Participants
- 206 patients
- Comparison
- Pulsed field ablation (PFA)-based pulmonary vein isolation (PVI) with PWI vs PFA-based PVI alone
- PVI with PWIn = 102
- PVI alonen = 104reference
- Primary endpoint
- First recurrence of atrial tachyarrhythmia, detected by continuous implantable cardiac monitor (ICM) monitoring, blinded adjudication
- Follow-up
- Days 91 to 365 after ablation
Methodological detailsinvestigator-initiated, multicentre, superiority, blinded end-point adjudication, 6 centres in Switzerland
- Investigator-initiated
- Multicentre
- Superiority
- Blinded end-point adjudication
- 6 centres in Switzerland
Primary result
Atrial tachyarrhythmia recurrence · days 91 to 365
Relative risk
0.75
95% CI 0.51–1.09
P = 0.13
Events by treatment group
PVI with PWI vs PVI alone
RR 0.75 (95% CI 0.51–1.09); P = 0.13
As reported in the abstract
Secondary outcomes
| Outcome | RR (95% CI) | |
|---|---|---|
| Arrhythmia recurrence by minimum episode duration · days 91 to 365 — PVI with PWI vs PVI alone · ≥1 hour | 0.64 (0.41–0.99) | |
| Arrhythmia recurrence by minimum episode duration · days 91 to 365 — PVI with PWI vs PVI alone · ≥6 hours | 0.62 (0.38–1.03) | |
| Arrhythmia recurrence by minimum episode duration · days 91 to 365 — PVI with PWI vs PVI alone · ≥1 day | 0.37 (0.18–0.78) | |
| Arrhythmia recurrence by minimum episode duration · days 91 to 365 — PVI with PWI vs PVI alone · ≥2 days | 0.40 (0.18–0.88) | |
| Arrhythmia recurrence by minimum episode duration · days 91 to 365 — PVI with PWI vs PVI alone · ≥7 days | 0.51 (0.22–1.23) | |
| 0.20.5125Relative risk (log scale) |
Prespecified secondary outcomes
- 22 of 29 not significantly different
Safety
| Outcome | PVI with PWI | PVI alone | |
|---|---|---|---|
| Safety composite (tamponade, phrenic nerve palsy, vascular complications, stroke/TIA, atrioesophageal fistula, death) · up to day 90 | 2 events | Not reported in the abstract | PVI alone: not reported in the abstract |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Pulmonary Vein Isolation Using Pulsed Field Ablation With vs Without Posterior Wall Isolation in Patients With Symptomatic Persistent Atrial Fibrillation: The PIFPAF-PFA Randomized Clinical Trial. JAMA. Published 29 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it