A Comparative Analysis of Long‐Term Procedural Outcomes Following Circular Array Pulsed Field and Radiofrequency Ablation

INTRODUCTION: The circular array (CA) pulsed field ablation (PFA) system is the first FDA-approved PFA technology for atrial fibrillation (AF), but real-world long-term outcome data remain limited. OBJECTIVE: To compare 1-year procedural outcomes and arrhythmia recurrence following CA PFA versus clinically matched radiofrequency (RF) ablation. METHODS: In this prospective single-center study, 36 consecutive patients underwent de novo AF ablation with the CA catheter and were matched 1:1 to RF controls by age, sex, left atrial size, body mass index, ejection fraction, and AF type. A previously described lesion optimization strategy with pole 5 anchoring was applied in all PFA cases. The primary endpoint was a composite of AF recurrence, antiarrhythmic use, cardioversion beyond the blanking period, or repeat ablation at 1 year. RESULTS: Baseline characteristics were similar between groups. Procedure and left atrial dwell times were significantly shorter with CA PFA (124 vs. 179 min; 72 vs. 115 min; both p < 0.001). No complications occurred in the PFA group, compared with two access-site hematomas in RF. The composite endpoint occurred less often with PFA (22% vs. 36%, p = 0.195). In multivariable analysis, PFA was associated with a lower risk of recurrence (aOR: 0.50, p = 0.081). CONCLUSIONS: CA PFA, performed with lesion optimization techniques, was safe, efficient, and at least as effective as RF ablation at 1 year. This study represents the first controlled, real-world comparison of long-term outcomes between CA PFA and RF ablation.