SPC365

One Thousand Cases of Pulsed-Field Ablation: Real-World Insights

Session: Sessão de Posters 05 - Ablação por campo pulsado: da viabilidade à fisiologia
Speaker: Pedro Pulido Adragão

Congress: CPC 2026
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Session Type: Posters Eletrónicos
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Authors: Samuel Azevedo; Rita Almeida Carvalho; Daniel Gomes; Daniel Matos; Gustavo Rodrigues; João Carmo; Francisco Moscoso Costa; Pedro Galvão Santos; Pedro Carmo; Diogo Cavaco; Francisco Bello Morgado; Pedro Pulido Adragão

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Introduction:</span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif"><span style="color:black">Pulmonary vein isolation (PVI) is the standard catheter-based treatment for atrial fibrillation (AF). Due to its safety profile and efficacy, pulsed field ablation (PFA), a non-thermal energy, has been increasingly adopted as the default strategy across many centers. We aimed to analyse the real-world efficacy and safety of PFA for the treatment of atrial arrhythmias in a tertiary high-volume center.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Methods:</span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif"><span style="color:black">All patients undergoing PFA for atrial tachyarrhythmias (i.e., AF and atrial flutter [AFL]) between July 2022 and November 2025 were included in the registry. Baseline characteristics included age, sex, left atrial volume (LAVi), left ventricular ejection fraction and history of prior catheter ablation.&nbsp;Procedural metrics included procedure duration, fluoroscopy time, and use of general anesthesia/sedation. The outcome of interest was arrhythmia recurrence, defined as AFL/ AF documented on ECG, Holter or clinical records after a 3-months period. Safety endpoint encompassed periprocedural complications, including cardiac tamponade, stroke, vascular access complications, and death.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Results:</span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif"><span style="color:black">A total of 1000 patients were included (mean age 64&plusmn;11years, 62,5% male, LAVI 62&plusmn;24, 51% paroxysmal AF, 15% atypical atrial flutter, 21% redo procedures). The PFA systems used were Farapulse (73%), Varipulse (18%), Volt (7%) and Affera (2%). Regarding ablation sets, most patients underwent PVI alone (58%) or combined with other lesions posterior wall isolation (32,6%), posterior mitral isthmus line (10,5%), anterior line (2,6%) and cavotricuspid isthmus isolation (5,3%). Mean procedure time was 75&plusmn;26min, and fluoroscopy duration was 8.5&plusmn;6min. A total of 748 procedures (75%) were performed under general anesthesia (GA), whereas the others were under sedation with remifentanil, dexmedetomidine and midazolam. Periprocedural complications were documented in 0.8% (2 tamponade, 2 vascular access). During a median follow-up of 10 months (IQR 6-14), a total of 13% suffered arrhythmia recurrence. Results were not different whether performed under GA or sedation. Efficacy was not significantly different when compared to our center and other high-volume center registries of AF ablation using thermal energies (RF or cryo).</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Conclusion:</span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:12px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif"><span style="color:black">In this comprehensive evaluation of&nbsp;</span>1000 PFA cases</span><strong>,</strong>&nbsp;</span></span></span>the procedure showed a good efficacy and safety profile. PFA has become the standard catheter-based treatment of AF.</p>