Pulsed field ablation (PFA) is a non-thermal ablative modality using a strong electrical field created around a dedicated catheter to produce pores in the cellular membrane. As the amount of energy required to produce electroporation is highly tissue dependent, the atrial myocardium can be specifically targeted while sparing adjacent tissues. This new ablation modality could increase the safety of pulmonary vein isolation (PVI) procedures compared to PVI using thermal energies. Real-life clinical data are still limited.

To assess safety and one-year efficacy of PVI performed using PFA.

We included all patients who underwent PVI for symptomatic atrial fibrillation (AF) using PFA in our hospital between June 2021 and June 2022. A 12 Fr multi-electrode pentaspline PFA catheter was advanced into the left atrium. Two applications (2.5sec and 2kV per application) were performed in “basket” configuration, then the catheter was slightly rotated (30–40°) before delivery of 2 additional applications. This sequence of ablation was repeated in “flower” configuration. PVI was assessed with the PFA catheter. A 24-hour holter monitoring was performed at 4-month and one-year follow-up. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence ≥30seconds after a 3-month blanking period.

The population consisted of 102 patients (72 paroxysmal AF, 30 persistent AF) with a mean age of 59±13 yo (Table 1). The mean procedure duration was 39±13min, and mean fluoroscopy duration was 8±3min (4±3Gy.cm²). PVI was confirmed for all veins in all patients at the end of the procedures. Pericardial effusion occurred in 1 patient during the early phase of our experience (patient n^o 8). There was no other complication. After a mean follow-up of 13±3 months, the one-year Kaplan-Meier estimate for freedom from atrial arrhythmia was 90% (95%CI 86–97%) (Fig. 1). AF recurrence occured in 6/102 patients (6%) during the 3-month blanking period only. At last follow-up, 25/102 patients (25%) remained under anti-arrhythmic drugs and 64/102 (63%) remained under anticoagulant therapy. 6 patients underwent a redo procedure: pulmonary vein reconnection was observed in 5/6.

PVI performed with PFA appeared safe and efficient with short procedure and acceptable fluoroscopy durations. Further data regarding long-term efficacy are now required.