Arrhythmias & electrophysiology
Pulsed field ablation for atrial fibrillation in patients with heart failure: insight from the ATHENA registrys
Authors' conclusion
PFA with the pentaspline catheter appears to be an effective treatment for AF in patients with HF. Freedom from AF and atrial arrhythmias post-PFA was highest in patients with paroxysmal AF and no history of HF, with no significant differences observed in persistent AF patients.
Study context
- Population
- Consecutive patients undergoing first-time pentaspline pulsed-field ablation (PFA) for atrial fibrillation (AF) (68.5% paroxysmal, 31.5% persistent), ATHENA registry176 (14.4%) with heart failure (HF)
- Participants
- 1,224 patients
- Exposure
- HF vs no HF in patients undergoing pentaspline PFA for AF
- HF with preserved ejection fraction (HFpEF)n = 40
- HFmrEF/rEFn = 136
- Outcome
- Freedom from documented atrial arrhythmias >30 s after a 2-month blanking period
- Follow-up
- 1-year follow-up
Methodological detailsconsecutive patients, stratified by HF subtype, AAD use left to physician discretion
- Consecutive patients
- Stratified by HF subtype
- AAD use left to physician discretion
Main finding
As reported in the abstract
Freedom from any atrial arrhythmias (Kaplan-Meier)
HR for atrial arrhythmia recurrence
1.5
95% CI 1.1–2.1
P = 0.0133
By group
HFvs No HF
HR for atrial arrhythmia recurrence 1.5 (95% CI 1.1–2.1); P = 0.0133
- Overall freedom from any atrial arrhythmias
- 79.9%
Observational data: associations, not effects.
Further findings
| Outcome | No HF | HR for atrial arrhythmia recurrence (CI) | P value | |
|---|---|---|---|---|
| Freedom from atrial arrhythmias, paroxysmal AF (subgroup)HFvs No HF | 82.2% | 2.0 (1.3–3.1) | P = 0.0028 | |
| Freedom from atrial arrhythmias, persistent AF (subgroup)HFvs No HFNo differences | 77.9% | 1.1 (0.7–1.7) | P = 0.7065 | |
| 0.20.5125HR for atrial arrhythmia recurrence (log scale) |
- Freedom from atrial arrhythmias, paroxysmal AF (subgroup): HF 68.6%
- Freedom from atrial arrhythmias, persistent AF (subgroup): HF 76.4%
Original publication
Pulsed field ablation for atrial fibrillation in patients with heart failure: insight from the ATHENA registrys. Europace. Published 17 March 2026. doi:10.
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