Incidence of acute pericarditis after pulsed-field ablation for the treatment of atrial fibrillation

Abstract Introduction Pulsed-field ablation (PFA) has emerged as a novel treatment strategy for patients with atrial fibrillation (AF). While traditional thermal ablation modes such as radiofrequency energy or cryoballoon energy showed an acute pericarditis rate of 0.5 – 4%, little is known about the incidence of acute pericarditis after PFA. Purpose To assess the incidence of acute pericarditis using PFA for the treatment of AF. Method Patients undergoing catheter ablation for AF using PFA were consecutively enrolled in a prospective registry in a tertiary referral center between January 2022 and January 2024. After PFA, all patients received a clinical assessment for cardiothoracic symptoms including cardiac auscultation, 12-lead ECG and transthoracic echocardiography. A clinical diagnosis of acute pericarditis was established according to the 2015 European Society of Cardiology (ESC) guidelines by the presence of at least 2 of the following criteria within 90 days after PFA: 1) pleuritic chest pain; 2) friction rub; 3) new widespread ST-elevation or PR depression on ECG; 4) pericardial effusion. Suspected acute pericarditis was diagnosed if 1 criterion was fulfilled. Results A total of 388 patients with AF (median age 67.5 years, 32% female) underwent pulmonary vein isolation using PFA. 0 (0%) patients fulfilled ≥ 2 ESC criteria required for diagnosis of acute pericarditis. Suspected acute pericarditis within 90 days after the procedure was found in 17 (4.4%) patients. 29 (7.5%) patients reported some sort of cardiothoracic symptoms (chest pain, chest tightness, chest discomfort, shortness of breath or pleuritic chest pain). Among them, 6 (1.5%) patients received anti-inflammatory drug treatment due to suspected pericarditis. 0 (0%) patients had a friction rub, 6 (1.5%) patients showed PR depression (no ST-elevation) and 5 (1.3%) patients demonstrated pericardial effusions. None of the pericardial effusions required drainage. Conclusion In this large cohort of patients undergoing PFA for AF, no patients suffered acute pericarditis according to current ESC criteria. Any type of cardiothoracic symptoms after PFA were noted in 7.5% of patients with 1.5% of patients requiring drug therapy.Graphical Abstract