Background: Pulsed-field ablation (PFA) is a new energy source to perform pulmonary vein isolation (PVI) by targeted electroporation of cardiomyocytes to treat atrial fibrillation. This new single-shot device has conceptual advantages that may result in higher efficacy compared to thermal energy sources.

Aim: To estimate early recurrences of AF after PVI using PFA.

Methods: Consecutive patients with symptomatic paroxysmal (pAF) or persistent AF (persAF) underwent PVI using PFA ablation catheter (Farawave®, Farapulse Inc, Menlo Park, CA, USA). Follow up data were obtained from Holter ECGs, wearables, review of medical records, and patient consultation. All information was combined to assess recurrence of AF.

Results: A total of 53 patients (mean age 67±13 y, 57% males, 58% persAF) were included in the analysis. Patients with persAF in comparison to pAF showed a similar CHA2DS2-VASc-score (3.1 vs. 2.7), but more left atrial enlargement (46 vs. 32 ml/m², p=0.001) and a lower left ventricular ejection fraction (47% vs. 55%, p=0.009). Rhythm evaluation could be executed in 48/53 patients for 90 days (blanking period) and in 41/53 beyond that up to a median follow-up of 101 days. AF recurred early within the blanking in 13/29 patients with persAF (44%) and in 7/19 patients with pAF (37%, p=0.583). Beyond the blanking period, AF recurred in 6/25 patients with persAF (24%), significantly more than in 0/16 patients with pAF (0%, p=0.034). 6/7 patients with recurrent AF in the blanking period showed AF limited to the first 20 days after PVI. One patient with persAF received a PVI Redo procedure after 3 months.

Conclusion: PFA results in freedom from AF in the majority of patients, including the first three months after the procedure. Further follow-up data are necessary to evaluate PV durability and to determine the efficacy of PFA compared to other, established energy sources.