Prognostic Impact of Early Recurrence Following Pulsed Field Ablation: A Meta‐Analysis

INTRODUCTION: The conventional 3-month blanking period after atrial fibrillation (AF) ablation has been applied irrespective of energy modality. Pulsed field ablation (PFA), a nonthermal technique, may elicit different tissue responses, questioning the appropriateness of this timeframe. We performed a meta-analysis to evaluate whether early recurrence of atrial tachyarrhythmia (ERAT) after PFA predicts late recurrence (LRAT) and to assess the duration of the traditional blanking period. METHODS: We systematically searched PubMed, Embase, and Cochrane Library through April 2025 for studies reporting ERAT and LRAT following PFA for AF. RESULTS: Nine studies (N = 3384) met the inclusion criteria. ERAT within 3 months post-PFA occurred in 14% of patients. Patients with ERAT had significantly higher odds of LRAT (pooled OR: 8.66; 95% CI: 5.69-13.18; p < 0.001). Importantly, ERAT in the first month was not predictive of LRAT (OR: 1.30; p = 0.52), whereas ERAT in Months 2-3 strongly predicted LRAT. CONCLUSION: ERAT after PFA is a strong predictor of LRAT, especially if occurring beyond the first month. These findings challenge the traditional 3-month blanking period for PFA and support shortening or individualizing this window. A tailored post-PFA surveillance approach focusing on arrhythmias beyond 1 month may improve timely interventions and long-term outcomes. Prospective studies are needed to refine blanking period duration for PFA.