Risk of Stroke and TIA With Pulsed Field Compared With Radiofrequency Ablation for Atrial Fibrillation.
Pulsed field ablation linked to higher 30-day stroke/transient ischemic attack risk than radiofrequency ablation
Risk of Stroke and TIA With Pulsed Field Compared With Radiofrequency Ablation for Atrial Fibrillation.
Pulsed field ablation (pulsed field ablation) of atrial fibrillation has been rapidly adopted, partly because of safety expectations compared with thermal ablation.
We conducted a prospective registry analyzing consecutive atrial fibrillation ablations at a high-volume US academic center between 2022 and 2026.
Pulsed field ablation carried higher 30-day stroke/transient ischemic attack risk than radiofrequency ablation
Patients receiving pulsed field ablation and radiofrequency ablation had similar baseline characteristics (mean age, 67 years; 31% female; 47% persistent atrial fibrillation; 7% previous stroke/transient ischemic attack), which were balanced after inverse probability of treatment weighting.
Compared with radiofrequency ablation, pulsed field ablation procedures were shorter (108 versus 144 minutes) and included more frequent posterior wall isolation (57% versus 31%).
In a high-volume, single-center registry with high clinical granularity and systematic patient follow-up, pulsed field ablation was associated with a significantly higher risk of stroke/transient ischemic attack at 30 days compared with radiofrequency ablation.
These results call for enhanced postmarket surveillance and dedicated prospective evaluation as the pulsed field ablation procedural volume continues to exponentially increase.