Predictive value of early recurrence after atrial fibrillation ablation: A propensity-matched comparison between pulsed field ablation and radiofrequency ablation

Background Early recurrences (ERs) occurring during the 3-month blanking period (BP) after radiofrequency (RF) ablation of atrial fibrillation (AF) are generally not considered an ablation failure. Pulsed field ablation (PFA) is a nonthermal energy source for AF ablation. Limited data exist on the clinical significance of ERs after PFA. Objective This study aimed to evaluate the incidence of ERs and their predictive value for late recurrence (LR) after PFA vs RF ablation. Methods Prospective, multicenter, observational study enrolling 434 consecutive patients with AF (62.3 ± 9.8 years; 66.1% males; 74.0% with paroxysmal AF) undergoing AF ablation with either PFA (n = 184) or RF (n = 250). Propensity matching for baseline characteristics yielded 117 matched pairs. ER was defined as atrial arrhythmia lasting >30 seconds occurring within 90 days after ablation. ER was further categorized as very ER (vER) (occurring within 30 days) and as medium ER (mER) (occurring between 30 and 90 days). Results The incidence of ER was similar in both groups: 13.7% in PFA vs 17.1% in RF (P = .469). ER was similarly predictive of LR in both groups (LR in ER+ patients; 81.3% in PFA vs 65.0% in RF; P = .279). In the PFA group, mER had a significantly higher positive predictive value for LR than vER (100.0% vs 50.0%; P = .010). In the RF group, vER and mER showed a similar positive predictive value (61.5% vs 71.4%; P = .658). Conclusion ER occurring during BP predicts LR in both PFA and RF ablation. In PFA, mER seems to be more predictive for LR than vER, suggesting that the BP after PFA could be shortened to 1 month