Pulsed Field Ablation Is Associated With Fewer Post‐Procedural Pericardial Inflammatory Symptoms Compared With Radiofrequency Ablation

BACKGROUND: Acute pericarditis is an uncommon complication of thermal atrial fibrillation (AF) ablation, whereas milder pericardial inflammatory symptoms, typically pleuritic or positional chest pain, are more common and negatively affect post-procedural recovery. Pulsed field ablation (PFA), a non-thermal modality with tissue-selective properties, may reduce collateral pericardial injury. We compared post-procedural pericardial inflammatory symptoms and recovery after AF ablation using PFA vs. radiofrequency ablation (RFA). METHODS: This single-center observational study with prospective data collection included 150 patients undergoing catheter ablation for paroxysmal or persistent AF using focal PFA (n = 75) or RFA (n = 75). Patients were identified from the procedural workflow during the study period. Post-procedural pericardial inflammatory symptoms, chest pain severity (5-point scale), anti-inflammatory therapy use, length of hospital stay, and biomarkers of inflammation (CRP) and myocardial injury (hs-TnT) were assessed during hospitalization and structured post-discharge follow-up. RESULTS: Baseline characteristics were similar between groups. Post-procedural chest pain occurred more frequently after RFA than PFA (32% vs. 5.3%, p < 0.001), despite a significantly greater proportion of patients in the PFA group receiving lesion sets beyond pulmonary vein isolation (94.7% vs. 73.3%, p < 0.001). Anti-inflammatory therapy was prescribed more frequently after RFA (20% vs. 2.7%, p = 0.001), and hospital length of stay was longer [2 (1-2) vs. 1(1-1) days, p = 0.03). Procedure duration was shorter with PFA (86 ± 36 vs. 122 ± 55 min, p < 0.001). Median hs-TnT levels were higher after PFA [1288 (865-2137) vs. 1001 (652-1368] ng/L, p = 0.01), whereas CRP levels were similar [10.4 (4.9-23.3) vs. 10.5 (6.9-27.3) mg/L; p = 0.38]. CONCLUSIONS: PFA was associated with fewer post-procedural pericardial inflammatory symptoms, reduced need for anti-inflammatory therapy, and faster recovery compared with RFA. These findings suggest reduced pericardial irritation and improved patient-centered recovery after AF ablation.