Arrhythmias & electrophysiology
Risk of Stroke and Transient Ischemic Attack (TIA) With Pulsed Field Compared With Radiofrequency Ablation for Atrial Fibrillation
Main finding · Stroke/TIAResult — go to the resultWeighted risk difference 0.36% 95% CI 0.03%–0.70%Authors' conclusion
In a high-volume, single-center registry with high clinical granularity and systematic patient follow-up, PFA was associated with a significantly higher risk of stroke/TIA at 30 days compared with RFA.
Study context
- Population
- Consecutive AF ablations at a high-volume US academic centre, 2022–2026
- Participants
- 4,221 ablation procedures
- Exposure
- Pulsed field ablation (PFA) vs radiofrequency ablation (RFA) for AF ablation
- PFAn = 2,144
- RFAn = 2,077reference
- Outcome
- Stroke or TIA, independently adjudicated by blinded neurologists
- Follow-up
- Within 30 days
Methodological detailssingle-centre, propensity-score weighted (IPTW), blinded neurologist adjudication, Stroke/TIA events evenly distributed over the study period, no clustering around PFA adoption or operators; 12 operators
- Single-centre
- Propensity-score weighted (IPTW)
- Blinded neurologist adjudication
- Stroke/TIA events evenly distributed over the study period, no clustering around PFA adoption or operators; 12 operators
Main finding
Stroke/TIA · 30 days
Weighted risk difference
0.36%
95% CI 0.03%–0.70%
P = 0.03
Events by group
PFA vs RFA
weighted risk difference 0.36% (95% CI 0.03%–0.70%); P = 0.03
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
Procedure duration
Posterior wall isolation
Exploratory mediation analysis
- Did not identify more extensive ablation as an independent risk factor for stroke (limited by low event rates)
Safety
Other procedural complications (weighted)
- Low and similar between PFA and RFA
- <1%
Original publication
Risk of Stroke and TIA With Pulsed Field Compared With Radiofrequency Ablation for Atrial Fibrillation. Circulation. Published 25 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it