Atrial Fibrillation ablation using variable loop pulse field ablation in the real world: an observational study

Abstract Background Pulsed-field ablation (PFA) has demonstrated favorable safety and procedural efficiency for pulmonary vein isolation (PVI). This study aimed to compare procedural characteristics in patients with paroxysmal and persistent atrial fibrillation (AF) undergoing PVI with or without posterior wall isolation (PWI) using PFA versus radiofrequency ablation (RFA). Methods We conducted a monocentric, retrospective observational study on consecutive patients scheduled for AF ablation with a variable loop PFA catheter between March and September 2024. A control group, matched by age, sex, and CHA2DS2-VASc score, was treated with RFA. Patients with paroxysmal AF underwent PVI only, while those with persistent AF received both PVI and PWI. Results A total of 78 patients were included, with 39 in each group (PFA and RFA). Baseline demographics and AF characteristics were similar between groups. There was a trend toward longer procedure time in the PFA group (57±19 vs. 51±16 minutes; p=0.054). Most patients underwent zero-fluoroscopy procedures (PFA: 85%, RFA: 97%; p=0.11). PVI was achieved in all patients, although fewer touch-up applications were needed for the right superior pulmonary vein (RSPV) in the PFA group (PFA: 2.6% vs. RFA: 21%; p=0.029). PWI was successful in all PFA patients, while only 66% achieved posterior wall block in the RFA group (p=0.008). No procedural complications occurred in either group. Conclusion VLPFA appears safe and effective for both paroxysmal and persistent AF, requiring fewer touch-ups for RSPV isolation and achieving more consistent posterior wall block than RFA.