Feasibility and Safety of Pulsed‐Field Ablation for Persistent Atrial Fibrillation: A Prospective Study

INTRODUCTION: Pulsed-field ablation (PFA) is a novel nonthermal ablation approach using rapid electrical pulses to cause cardiac cell apoptosis via electroporation. Our study aims to investigate the feasibility and safety of PFA for persistent atrial fibrillation (PeAF). METHODS: Thirty-two consecutive patients diagnosed with PeAF were enrolled in our study. All patients underwent PFA treatment using the strategy including pulmonary vein isolation (PVI), left atrial posterior wall (LAPW) isolation, cavotricuspid isthmus (CTI) block, and mitral isthmus (MI) block. Acute and follow-up procedure outcomes were evaluated, and adverse events related to the ablation procedure were also observed. RESULTS: One-year survival free from atrial tachyarrhythmia post-ablation was 65.6%. Acute success rates for PVI, LAPW isolation, CTI block, and MI block were 100%, 100%, 96.9%, and 81.3%, respectively. Eleven cases (34.4%) experienced atrial tachyarrhythmia recurrence, with eight cases being atrial fibrillation (AF) recurrence and three cases being atrial flutter recurrence. Three patients underwent repeat ablation. Minor complications were encountered in four patients with asymptomatic cerebral lesions. Vagal responses were commonly observed during the procedure. No severe coronary vasospasm or severe hemolysis occurred in our cohort. CONCLUSION: PFA with the strategy including PVI, LAPW isolation, CTI block, and MI block is feasible, safe, and associated with a high rate of freedom from atrial tachyarrhythmia recurrence at 1 year in patients with PeAF. TRIAL REGISTRATION: This study registered at the Chinese Clinical Trial Registry (ChiCTR2300068980).