P‐Wave Parameter Changes After Pulsed‐Field Ablation, Cryoballoon Ablation and Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: An Observational Cohort Study

ABSTRACT Background Pulmonary vein isolation (PVI) is central to controlling paroxysmal atrial fibrillation (AF). Pulsed‐field ablation (PFA) offers a non‐thermal alternative to conventional thermal techniques. The study compares changes in P‐wave parameters following PFA, radiofrequency ablation (RF), and cryoballoon ablation (Cryo). Methods We retrospectively analysed 283 patients undergoing first‐time PVI (RF 101, Cryo 125, PFA 57). Digital electrocardiograms (ECGs) were evaluated for P‐wave duration (PWD), voltage (PWV), dispersion (PWDisp), and terminal force in lead V1 (PTFV1) before and immediately after ablation. AF recurrence was assessed at 12 months. Analyses were adjusted for left atrial volume index (LAVI) and post‐procedural anti‐arrhythmic drug (AAD) use. Results At 12 months, 215 patients (76%) remained free of AF (RF 76%, Cryo 74%, PFA 79%; p = 0.78). Baseline PWD was 128.5 ± 14 ms (RF), 123.7 ± 15 ms (Cryo), and 124.2 ± 16 ms (PFA). Post‐ablation, mean ΔPWD was +12.2 ms (RF), +8.5 ms (Cryo), and + 4.7 ms (PFA). PTFV1 decreased after all modalities: RF −3.3 to −4.6 mm·ms ( p < 0.001), Cryo −3.4 to −5.3 mm·ms ( p = 0.002), PFA −3.6 to −5.2 mm·ms ( p = 0.005). No significant intergroup differences were observed ( p = 0.39). Patients with AF recurrence ( n = 68) had longer baseline PWD (128 ± 16 vs. 125 ± 14 ms, p = 0.12), longer post‐procedural PWD (138 ± 17 vs. 129 ± 15 ms, p = 0.004), and larger LAVI (29.1 ± 7.9 vs. 25.3 ± 8.5 mL/m 2 , p = 0.03). In multivariable Cox models, increased post‐procedural PWD independently predicted recurrence (HR: RF 1.17, Cryo 1.14, PFA 1.13; all p < 0.05). Conclusions PFA, RF, and Cryo produce similar acute ECG changes. Post‐procedural PWD was the strongest predictor of AF recurrence, independent of atrial size and AAD use.