Algorithm-guided personalized pulsed field ablation for persistent atrial fibrillation: a prospective multicentre study with matched external comparison

Abstract

PFA was delivered mainly in the flower configuration until complete regional coverage of the highlighted areas, avoiding gaps between targeted areas and/or anatomical boundaries. If AF persisted, re-mapping and further ablation of the new highlighted areas could be performed. AF termination was defined as direct restoration of sinus rhythm (SR) or organization into atrial tachycardia (AT) followed by AT ablation. The external comparator was drawn from the France PFA registry (NCT06497933) and restricted to patients with persAF who had undergone PVI plus PWI using the pentaspline PFA catheter alone. In all of them, PVI and PWI were confirmed at the end of the procedure using mapping and pacing from the pen-taspline catheter. Propensity score matching (age, sex, AF type, LA dilation, rhythm at onset, CHA 2 DS 2 -VA) yielded a PVI + PWI reference group. Follow-up comprised 12-lead ECG and 24 h Holter at 4 months and 1 year, with additional testing if symptomatic; monitoring was identical in both groups. The primary endpoint was freedom from any atrial arrhythmia (>30 s) at 12 months after a single procedure, without a blanking period.