De Novo Pulmonary Vein Isolation by Means of Pulsed Field Versus Conventional Thermal Ablation of Paroxysmal Atrial Fibrillation in Women: Safety, Efficiency, and Efficacy

Background Women are frequently underrepresented in studies investigating atrial fibrillation (AF) ablation. We evaluated the acute efficacy, safety, and mid‐term outcomes of de novo paroxysmal AF ablation in female patients using a pentaspline pulsed‐field ablation (PFA) versus thermal‐based technologies. Methods In a cohort of consecutive female patients with paroxysmal AF undergoing de novo pulmonary vein isolation, enrolled in the ATHENA‐CHARISMA (Advanced Technologies For Successful Ablation of AF in Clinical Practice ‐ Catheter Ablation of Arrhythmias With High‐DensityMapping System in the Real WorldPractice) registries, thermal ablation systems (radiofrequency or cryoablation) were compared to the PFA by means of a propensity score matching (ratio 1:1:1). Results One‐thousand one female patients (mean age 63±10 years, mean left ventricular ejection fraction 60.8±6%) were included: 376 (37.6%) underwent cryoablation ablation, 342 (34.2%) radiofrequency ablation, and 283 (28.3%) PFA. Propensity score matching yielded 684 patients (228 per group). The PFA group had significantly shorter skin‐to‐skin time (60 [50–75] minutes) compared with both radiofrequency (120 [90–145] minutes, P