Pulsed Field Ablation Is Associated With Favorable Outcomes After Atrial Fibrillation Ablation: Insights From the Polish National Ablation Registry (POL-AR).
Piotr Urbanek, Robert Bodalski, Michał Orczykowski, Ilona Kowalik, Andrzej Głowniak, Piotr Ponikowski, Oskar Kowalski, Paweł Derejko, Mariusz Pytkowski, Łukasz Szumowski
{"title":"Pulsed Field Ablation Is Associated With Favorable Outcomes After Atrial Fibrillation Ablation: Insights From the Polish National Ablation Registry (POL-AR).","authors":"Piotr Urbanek, Robert Bodalski, Michał Orczykowski, Ilona Kowalik, Andrzej Głowniak, Piotr Ponikowski, Oskar Kowalski, Paweł Derejko, Mariusz Pytkowski, Łukasz Szumowski","doi":"10.1111/jce.70514","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The Polish National Ablation Registry (POL-AR), mandatory for all centers performing catheter ablation and integrated with National Health Fund data, enables prospective analysis of a nationwide cohort with complete inclusion of all consecutive patients.</p><p><strong>Objective: </strong>We aimed to assess real-world safety profiles and clinical outcomes of atrial fibrillation (AF) ablation modalities-radiofrequency (RF), cryoballoon (CRYO), and pulsed-field ablation (PFA)-and to report the first-year PFA experience in Poland.</p><p><strong>Methods: </strong>All AF ablations in 2023 were prospectively analyzed in POL-AR and cross-referenced with National Health Fund data. Only centers with complete reporting were included. Patients were grouped by modality. Major complications, unplanned hospitalizations, cardioversions, repeat ablations, and deaths were assessed at 1 year. Multivariate analysis identified independent predictors of outcomes.</p><p><strong>Results: </strong>Twenty-eight centers reported 3430 patients (CRYO: 2125; RF: 1098; PFA: 207). Procedure time was longest for RF (median 120 min) versus CRYO (75 min) and PFA (65 min); (p < 0.001). No major complications occurred with PFA. Phrenic nerve injury persisted in 1.51% of CRYO, 0.09% of RF, and 0% of PFA patients (p < 0.001). Pericardial effusion was more frequent after RF (0.91% vs. 0.34% for CRYO + PFA; p = 0.032). Overall complication rates were lowest with PFA (0% vs. RF: 2.19%, CRYO: 2.59%). PFA patients required fewer cardioversions during follow-up (p = 0.017). Predictors of poor outcome included age, female sex, left atrium (LA) size, hypertension, and hypertrophic cardiomyopathy (HCM). Favorable outcome was independently associated with higher left ventricular ejection fraction (LVEF), paroxysmal AF, and PFA use (HR 0.70, p = 0.04).</p><p><strong>Conclusion: </strong>In the POL-AR registry, PFA was independently associated with favorable outcomes after AF ablation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2385-2392"},"PeriodicalIF":2.4000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jce.70514","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/9/27 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The Polish National Ablation Registry (POL-AR), mandatory for all centers performing catheter ablation and integrated with National Health Fund data, enables prospective analysis of a nationwide cohort with complete inclusion of all consecutive patients.
Objective: We aimed to assess real-world safety profiles and clinical outcomes of atrial fibrillation (AF) ablation modalities-radiofrequency (RF), cryoballoon (CRYO), and pulsed-field ablation (PFA)-and to report the first-year PFA experience in Poland.
Methods: All AF ablations in 2023 were prospectively analyzed in POL-AR and cross-referenced with National Health Fund data. Only centers with complete reporting were included. Patients were grouped by modality. Major complications, unplanned hospitalizations, cardioversions, repeat ablations, and deaths were assessed at 1 year. Multivariate analysis identified independent predictors of outcomes.
Results: Twenty-eight centers reported 3430 patients (CRYO: 2125; RF: 1098; PFA: 207). Procedure time was longest for RF (median 120 min) versus CRYO (75 min) and PFA (65 min); (p < 0.001). No major complications occurred with PFA. Phrenic nerve injury persisted in 1.51% of CRYO, 0.09% of RF, and 0% of PFA patients (p < 0.001). Pericardial effusion was more frequent after RF (0.91% vs. 0.34% for CRYO + PFA; p = 0.032). Overall complication rates were lowest with PFA (0% vs. RF: 2.19%, CRYO: 2.59%). PFA patients required fewer cardioversions during follow-up (p = 0.017). Predictors of poor outcome included age, female sex, left atrium (LA) size, hypertension, and hypertrophic cardiomyopathy (HCM). Favorable outcome was independently associated with higher left ventricular ejection fraction (LVEF), paroxysmal AF, and PFA use (HR 0.70, p = 0.04).
Conclusion: In the POL-AR registry, PFA was independently associated with favorable outcomes after AF ablation.
期刊介绍：
Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
