Pulsed field ablation benefits most patients with AF treated in usual clinical care

Catheter ablation using pulsed field energy leads to freedom from atrial arrhythmia in many patients with atrial fibrillation (AF), according to data from MANIFEST-PF*.

MANIFEST-PF was a retrospective, multinational, patient-level registry that included all patients undergoing postapproval treatment with a multielectrode 5-spline pulsed field ablation catheter for AF. Pulsed field ablation applies ultra-rapid electrical pulses to cause cell death via irreversible electroporation.

The primary effectiveness endpoint was freedom from clinical atrial arrhythmia (AF/atrial flutter/atrial tachycardia) of ≥30 seconds based on electrocardiographic data after a 3-month blanking period (on or off antiarrhythmic drugs). Safety endpoints included the composite of acute (<7 days postprocedure) and latent (>7 days) major adverse events.

Pulsed field ablation was performed in 1,568 patients with AF (mean age 64.5 years, 35 percent women) at 24 European centres (77 operators). Of these patients, 65 percent had paroxysmal AF and 32 percent had persistent AF. The mean CHA2DS2-VASc score in the entire sample was 2.2, the median left ventricular ejection fraction was 60 percent, and left atrial diameter was 42 mm.

The majority of the patients (99.2 percent) achieved pulmonary vein isolation. Over a median follow-up of 367 days, the 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was 78.1 percent (95 percent confidence interval, 76.0–80.0).

Of note, the rate of clinical effectiveness with pulsed field ablation was significantly higher in the group of patients with paroxysmal AF than in the group of those with persistent AF (81.6 percent vs 71.5 percent; p=0.001).

The frequency of acute major adverse events was 1.9 percent.

*Multi-National Survey on the Methods, Efficacy, and Safety on the Post-Approval Clinical Use of Pulsed Field Ablation