Arrhythmias & electrophysiology
Pulmonary Vein Isolation (PVI) Durability After Pulsed Field Ablation (PFA) or Radiofrequency Ablation (RFA) in Persistent-AF: Insights From a Mandated Prospective Remapping Study
Main finding · PVI durabilityResult — go to the resultAdjusted odds ratio 1.20 95% CI 0.37–3.88Authors' conclusion
In patients with persistent AF, PFA demonstrated PVI durability comparable to RFA. Arrhythmia recurrence occurred in a substantial proportion of patients with durable PVI, suggesting a role for non-PV mechanisms.
Study context
- Population
- Persistent atrial fibrillation (AF) patients undergoing PVIenrolled, 51 underwent the mandated remapping procedure · RFA (phase 1) 30 · PFA (phase 2) 30
- Participants
- 60 patients
- Exposure
- PVI durability and arrhythmia recurrence between pulsed field ablation (PFA) and radiofrequency ablation (RFA)
- PFAn = 30
- RFAn = 30
- Outcome
- PVI durability
- Follow-up
- Remapping after a median of 7.2 months
Methodological detailsprospectively enrolled, mandatory remapping procedure performed after 6 months regardless of recurrence, RFA in phase 1, PFA in phase 2, 7-day Holter electrocardiograms after 3, 6, and 12 months
- Prospectively enrolled
- Mandatory remapping procedure performed after 6 months regardless of recurrence
- RFA in phase 1, PFA in phase 2
- 7-day Holter electrocardiograms after 3, 6, and 12 months
Main finding
PVI durability
Adjusted odds ratio
1.20
95% CI 0.37–3.88
P = 0.77
Events by group
PFA vs RFA
adjusted OR 1.20 (95% CI 0.37–3.88); P = 0.77
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
PVI durability in the right superior PV · lowest durability
| Outcome | Adjusted HR (95% CI) | P value | |
|---|---|---|---|
| Freedom from recurrence after mandated redo procedure · 1-year follow-up | 0.80 (0.24–2.64) | P = 0.71 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- Freedom from recurrence after mandated redo procedure — Freedom from recurrence
- 70%
- Freedom from recurrence after mandated redo procedure: no difference between the 2 ablation technologies; comparator group not stated in the abstract
All PVs durably isolated
- Patients with all PVs durably isolated
- 26 patients (51%)
AF recurrence prior to the remapping procedure, by PV status
- Of 26 patients with durably isolated PVs, AF recurrence
- 9 (35%)
- Of 25 patients with reconnected PVs, AF recurrence
- 7 (28%)
Original publication
PVI Durability After PFA or RFA in Persistent-AF: Insights From a Mandated Prospective Remapping Study. JACC Clin Electrophysiol. Published 9 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it