Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry.

Background: Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.

Objective: This study aims to assess the efficacy and safety of PFA in patients with persistent AF.

Methods: Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected.

Results: The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87%), mitral isthmus ablation (37%), and cavo-tricuspid isthmus ablation (3%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69% vs. 56%, p = 0.013). While AF recurrence did not significantly differ (25% vs. 28%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8% vs. 22%, p < 0.001). Major complications occurred in 2.0% versus 1.0% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400).

Conclusions: PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.