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Multicenter Study
. 2025 Aug;36(8):1710-1720.
doi: 10.1111/jce.16583. Epub 2025 Apr 2.

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

Jun Hirokami  1 , Kyoung Ryul Julian Chun  1 , Stefano Bordignon  1 , Shota Tohoku  1 , Kars Neven  2   3 , Tobias Reichlin  4 , Yuri Blaauw  5 , Jim Hansen  6 , Raquel Adelino  7 , Alexandre Ouss  8 , Anna Füting  2   3 , Laurent Roten  4 , Bart A Mulder  5 , Martin H Ruwald  6 , Roberto Mené  7 , Pepijn van der Voort  8 , Nico Reinsch  2   3 , Thomas Kueffer  4 , Serge Boveda  7 , Elizabeth M Albrecht  9 , Boris Schmidt  1   10
Affiliations
Multicenter Study

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

Jun Hirokami et al. J Cardiovasc Electrophysiol. 2025 Aug.

Abstract

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.

Keywords: atrial fibrillation; extra pulmonary vein ablation; persistent AF; propensity score matching; pulmonary vein isolation; pulsed‐field ablation.

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Conflict of interest statement

Jun Hirokami: none. Kyoung Ryul Julian Chun is a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. Stefano Bordignon has received honoraria from Medtronic and Biosense Webster. Shota Tohoku: none. Kars Neven is a consultant for Biosense Webster, Boston Scientific, Field Medical, and LifeTech Scientific. Tobias Reichlin has received research grants from the Goldschmidt‐Jacobson Foundation, the Swiss National Science Foundation, the Swiss Heart Foundation, and the sitem insel support fund, all for work outside the submitted study. He has received speaker/consulting honoraria or travel support from Abbott/SJM, Bayer, Biosense‐Webster, Biotronik, Boston‐Scientific, Daiichi Sankyo, Farapulse, Medtronic, and Pfizer‐BMS, all for work outside the submitted study. He has received support for his institution's fellowship program from Abbott/SJM, Biosense‐Webster, Biotronik, Boston‐Scientific, and Medtronic for work outside the submitted study. Yuri Blaauw has received research grants from Medtronic and Atricure. He has received speaker/consulting honoraria from Abbott/SJM and Boston‐Scientific, all for work outside the submitted study. Jim Hansen: speakers fees from Boston Scientific and Biosense Webster. Raquel Adelino: none. Alexandre Ouss: none. Anna Füting: educational grant from Boston Scientific. Laurent Roten received research grants from Medtronic and speaker/consulting honoraria from Abbott and Medtronic. Bart A.Mulder: none. Martin H.Ruwald: none. Roberto Mené: none. Pepijn van der Voort: none. Nico Reinsch: consultant for Boston Scientific. Thomas Kueffer: none. Serge Boveda is consultant for Medtronic, Boston Scientific, Microport, and Zoll. Elizabeth M.Albrecht: salaried employees of Boston Scientific and Boris Schmidt is a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. Central illustration 1.

Figures

Figure 1
Figure 1
Study flowchart. Abbreviations: AF, atrial fibrillation; PFA, pulsed‐field ablation; PVI, pulmonary vein isolation.
Figure 2
Figure 2
Kaplan‐Meier curve of all atrial tachyarrhythmia‐free survival for (A) all patients and (B) patients who underwent propensity score matched analysis.
Figure 3
Figure 3
Kaplan‐Meier curve of atrial fibrillation (AF) and atrial tachycardia (AT)/atrial flutter (AFL)‐free survival. (A) Freedom from AF in all patients; (B) Freedom from AT/AFL in all patients; (C) Freedom from AF in patients who underwent propensity score matched analysis; (D) Freedom from AT/AFL in patients who underwent propensity score matched analysis. Abbreviation: AF, atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; PVI, pulmonary vein isolation.
Central illustration 1
Central illustration 1
A total of 457 persistent AF patients from EU‐PORIA were included in this trial and Propensity score matched (PSM) analysis was conducted. The Kaplan‐Meier curve of all‐atrial arrhythmia‐free survival for (A) all persistent patients and (B) patients who underwent PSM conducted to the higher recurrence rate in PVI + α group.
See this image and copyright information in PMC

References

    1. Verma A., Jiang C., Betts T. R., et al., “Approaches to Catheter Ablation for Persistent Atrial Fibrillation,” New England Journal of Medicine 372, no. 19 (2015): 1812–1822, 10.1056/nejmoa1408288. - DOI - PubMed
    1. Clarnette J. A., Brooks A. G., Mahajan R., et al., “Outcomes of Persistent and Long‐Standing Persistent Atrial Fibrillation Ablation: A Systematic Review and Meta‐Analysis,” EP Europace 20, no. FI3 (2018): f366–f376, 10.1093/europace/eux297. - DOI - PubMed
    1. Inoue K., Hikoso S., Masuda M., et al., “Pulmonary Vein Isolation Alone Vs. More Extensive Ablation With Defragmentation and Linear Ablation of Persistent Atrial Fibrillation: The EARNEST‐PVI Trial,” EP Europace 23, no. 4 (2021): 565–574, 10.1093/europace/euaa293. - DOI - PubMed
    1. Masuda M., Inoue K., Tanaka N., et al., “Long‐Term Impact of Additional Ablation After Pulmonary Vein Isolation: Results From Earnest‐PVI Trial,” Journal of the American Heart Association 12, no. 17 (2023): 1–12, 10.1161/JAHA.123.029651. - DOI - PMC - PubMed
    1. Calkins H., Hindricks G., Cappato R., et al., “2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation,” Heart Rhythm: Official Journal of the Heart Rhythm Society 14, no. 10 (2017): e275–e444, 10.1016/j.hrthm.2017.05.012. - DOI - PMC - PubMed

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