Patient Comfort and Response Pattern Following Pulsed-Field Ablation Compared to Radiofrequency Ablation for Atrial Fibrillation.

Background: Pulsed-field ablation (PFA) for atrial fibrillation (AF) offers several advantages compared to thermal ablation, however direct comparisons of patient-reported outcomes after PFA and radiofrequency ablation (RFA) are limited. This study aimed to assess patient experience following PFA or RFA in AF ablation performed under general anesthesia.

Methods: A retrospective study across a single integrated health system was conducted on consecutive patients who underwent PFA or RFA for AF under general anesthesia from March 2024 to December 2024. Data were collected from electronic medical records. Primary endpoints included postprocedural pain complaints and scores, need for postprocedure analgesic medication, and frequency of emergency department (ED) visits for procedure-related concerns.

Results: Two hundred patients (100 PFA and 100 RFA) were analyzed (age 73.2 ± 9.2 y, 38% female). Patients undergoing RFA had a significantly higher rate of ED visits compared to those who underwent PFA (17% vs. 6%, p < 0.05). The most common complaints prompting RFA ED visits were shortness of breath (29% of RFA ED visits), palpitations (23% of RFA ED visits), dizziness (18% of RFA ED visits), and other (30% of RFA ED visits). There were no statistically significant differences in postprocedural pain scores (RFA 1.70 vs. PFA 1.57, p = 0.61), requests for analgesic medications in the recovery area (RFA 36% vs. PFA 27%, p = 0.26), nor encounters made to the care team within 4 weeks following the procedure (RFA 57% vs. PFA 44%, p = 0.20).

Conclusion: In this retrospective study, patients undergoing PFA for AF under general anesthesia experienced fewer ED visits for procedure-related issues compared to those undergoing RFA. While these clinical endpoints potentially suggest improved procedural recovery with PFA compared to RFA, larger prospective studies using patient-reported outcome measures are warranted.