De Novo Pulmonary Vein Isolation by Means of Pulsed Field Versus Conventional Thermal Ablation of Paroxysmal Atrial Fibrillation in Women: Safety, Efficiency, and Efficacy
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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 <0.001) and cryoablation (75 [60–100] minutes, P <0.001), while fluoroscopy time was similar among groups (15 [11–21] minutes for PFA, 14 [10–20] minutes for cryoablation, P =0.599 versus PFA and 14 [9–20] minutes for radiofrequency, P =0.454 versus PFA). Overall complication rate was 3.4% and it was significantly higher after thermal ablation than PFA (4.6% versus 0.9%, OR, 5.5, 95% CI, 1.3–23.5, P =0.0227). During a median follow‐up of 413 [277–589] days, 139 (20.3%) patients experienced AF recurrence. The Kaplan–Meier estimated freedom from AF at 1‐year follow‐up was 86.8% with PFA, 84.6% with cryoablation, and 83.3% with radiofrequency (log‐rank P value: 0.839). Conclusions Among this cohort of female patients, de novo paroxysmal AF using a pentaspline PFA system demonstrated significantly shorter procedural times, and a lower complication rate compared with thermal ablation systems. One‐year follow‐up revealed comparable rates of AF freedom across all ablation modalities. Registration ATHENA (Advanced Technologies For Successful Ablation of AF in Clinical Practice). URL: http://clinicaltrials.gov/ ; Unique identifier: NCT05617456. CHARISMA (Catheter Ablation of Arrhythmias With High‐Density Mapping System in the Real World Practice). URL: http://clinicaltrials.gov/ ; Unique Identifier: NCT03793998.
Authors: Valentina Ribatti, Antonio Dello Russo, Stefania Riva, Maurizio Malacrida, Stefano Bianchi, Francesco Solimene, Saverio Iacopino, Antonio De Simone, Antonio Rossillo, Gemma Pelargonio, Giulio Zucchelli, Ruggero Maggio, Maurizio Russo, Domenico Pecora, Matteo Bertini, Stefano Bandino, Mario Volpicelli, Paolo Compagnucci, Valerio De Sanctis, Matteo Anselmino, Roberto Rordorf, Gianluca Zingarini, Giovanni Rovaris, Elena Agus, Sakis Themistoclakis, Gianfranco Mitacchione, Roberta Mea, Yari Valeri, Claudio Tondo, Michela Casella
Institutions: Centro Cardiologico Monzino, Marche Polytechnic University, Boston Scientific (United States), Maria Cecilia Hospital, Ospedale San Bortolo, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Ospedale San Filippo Neri, Fondazione Poliambulanza Istituto Ospedaliero, University of Ferrara, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Turin, Policlinico San Matteo Fondazione, Azienda Ospedaliera San Gerardo, Azienda Ospedaliera G. Brotzu, Ospedale dell' Angelo, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, University of Milan
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
OpenAlex ID: W7128733463