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. 2025 Jun;22(6):1375-1383.
doi: 10.1016/j.hrthm.2024.11.031. Epub 2024 Nov 22.

Pulsed field ablation for atrial fibrillation with a novel simplified protocol: The PFA dose study

Patrick Badertscher  1 , Corinne Isenegger  2 , Rebecca Arnet  2 , Fabian Jordan  2 , Sven Knecht  2 , Philipp Krisai  2 , Gian Völlmin  2 , Jeanne du Fay de Lavallaz  2 , Josip Katic  3 , David Spreen  2 , Stefan Osswald  2 , Christian Sticherling  2 , Michael Kühne  2
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Free article

Pulsed field ablation for atrial fibrillation with a novel simplified protocol: The PFA dose study

Patrick Badertscher et al. Heart Rhythm. 2025 Jun.
Free article

Abstract

Background: Pulsed field ablation (PFA) with use of a pentaspline catheter for the treatment of atrial fibrillation is performed in a standardized fashion. Whether a reduced number of applications results in similar clinical outcomes has not been fully investigated.

Objective: This study aimed to assess a simplified PFA dosing protocol for pulmonary vein isolation (PVI) compared with a standard protocol.

Methods: Consecutive patients undergoing their first PVI by PFA were enrolled. In the simple PFA group, patients received 4 applications per pulmonary vein (2× basket and 2× flower configuration), whereas 8 applications per pulmonary vein (4× basket and 4× flower configuration) were used in the standard PFA group.

Results: We included 245 patients (32% female; median age, 66 years), 96 (39%) in the simple PFA group and 149 (61%) in the standard PFA group. Median procedure duration, left atrial dwell time, and fluoroscopy time were significantly shorter in the simple PFA group compared with the standard PFA group at 40 (25-55) minutes vs 53 (41-67) minutes (P < .001), 22 (13-37) minutes vs 37 (27-50) minutes (P < .001), and 9 (7-12) minutes vs 11 (9-14) minutes (P < .001), respectively. First-pass isolation was similar for the simple PFA group and the standard PFA group (95% vs 95%; P > .999). Overall, 4 procedural complications were observed, all in the standard PFA group (P = .303). During a median follow-up of 373 days, freedom from atrial arrhythmias was 79% in the simple PFA group and 77% in the standard PFA group (P = .767). Findings were confirmed in comparing only patients who received PVI with or without electroanatomic mapping.

Conclusion: The novel simplified PFA protocol was associated with increased procedural efficiency while maintaining noninferior efficacy and safety compared with the standard PFA protocol.

Keywords: Atrial fibrillation; Catheter ablation; Outcome; Pulmonary vein isolation; Pulsed field ablation.

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Conflict of interest statement

Disclosures Patrick Badertscher has received research funding from the University of Basel, the Stiftung für Herzschrittmacher und Elektrophysiologie, the Freiwillige Akademische Gesellschaft Basel, the Swiss Heart Foundation, and Johnson & Johnson and reports personal fees from BMS, Boston Scientific, and Abbott, all outside the submitted work. Jeanne du Fay de Lavallaz has received research funding from the University of Basel and from the Swiss Heart Foundation. Philipp Krisai reports speaker fees from BMS/Pfizer and grants from the Swiss National Science Foundation, Swiss Heart Foundation, Foundation for Cardiovascular Research Basel, and Machaon Foundation. Sven Knecht has received funding of the Stiftung für kardiovaskuläre Forschung and the Swiss Heart Foundation. Christian Sticherling: member of Medtronic Advisory Board Europe and Boston Scientific Advisory Board Europe; received educational grants from Biosense Webster and Biotronik and a research grant from the European Union’s FP7 program and Biosense Webster; and received lecture and consulting fees from Abbott, Medtronic, Biosense Webster, Boston Scientific, MicroPort, and Biotronik, all outside the submitted work. Michael Kühne reports grants from the Swiss National Science Foundation (33CS30_148474, 33CS30_177520, 32473B_176178, and 32003B_197524), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel, and the University of Basel; grants from Bayer, BMS, Boston Scientific, Daiichi Sankyo, and Pfizer; personal fees from Abbott, Boston Scientific, and Daiichi Sankyo; and royalties from Springer Nature, all outside the submitted work. The other authors have no conflicts of interest to disclose.

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