Evidence map›Paper›PMID 41638753›Full record

ArticleOpen heart2026

Clinical outcomes of pulsed field versus radiofrequency ablation, incorporating posterior wall isolation, in persistent atrial fibrillation.

Omar Ahmed, Anthony Li, Ibrahim Zazai, Abhay Bajpai, Zia Zuberi, Mark Norman, Lisa Leung, Mark James Specterman, Manav Sohal, Elijah R Behr and 2 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Open heart, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Omar AhmedCity St George's University of London, London, UK omarahmed@nhs.net.ORCID 0000-0002-4416-8986
Anthony LiSt George's University Hospitals NHS Foundation Trust, London, UK.
Ibrahim ZazaiSt George's University Hospitals NHS Foundation Trust, London, UK.
Abhay BajpaiSt George's University Hospitals NHS Foundation Trust, London, UK.
Zia ZuberiSt George's University Hospitals NHS Foundation Trust, London, UK.
Mark NormanSt George's University Hospitals NHS Foundation Trust, London, UK.
Lisa LeungSt George's University Hospitals NHS Foundation Trust, London, UK.
Mark James SpectermanCity St George's University of London, London, UK.ORCID 0000-0001-8533-2140
Manav SohalSt George's University Hospitals NHS Foundation Trust, London, UK.
Elijah R BehrCity St George's University of London, London, UK.
Magdi SabaSt George's University Hospitals NHS Foundation Trust, London, UK.
Riyaz A KabaCity St George's University of London, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPersistent atrial fibrillation (AF) remains challenging to treat with catheter ablation. The left atrial posterior wall (PW) may represent an important non-pulmonary vein (PV) substrate; however, randomised trials have not demonstrated improved outcomes with adjunctive PW isolation (PWI), potentially reflecting technical limitations of thermal ablation rather than a lack of mechanistic relevance. Pulsed-field ablation (PFA) is a non-thermal ablation modality that selectively targets myocardial tissue and may enable safer and more consistent PWI. We compared real-world outcomes of PFA and radiofrequency ablation (RFA) for combined PV isolation and PWI in patients with persistent AF.

methods200 consecutive patients (100 PFA and 100 RFA) undergoing combined PVI and PWI were retrospectively followed for up to 12 months. Baseline characteristics were broadly similar; however, PFA patients had lower left ventricular ejection fraction (LVEF) (43.5% (35.5-55.5%) vs 47% (40-58), p=0.01) and higher CHA₂DS₂-VA risk score (3 (2-4) vs 2 (1-3), p=0.01). Primary outcomes were acute procedural success and freedom from recurrent atrial tachyarrhythmia (AT) at 6 and 12 months.

resultsPFA achieved near-universal PWI compared with RFA (99% vs RFA: 65%, p<0.005), with shorter procedure duration (106 vs 143.5 min, p<0.005), reduced left atrial dwell time (62 vs 98 min, p<0.005), and faster time to PVI and PWI (all p<0.005). Major non-vascular complications were uncommon (1.5%) and similar between groups. At 12 months, freedom from recurrent AT was higher with PFA (70% vs RFA 54%, p=0.03), with lower odds of first detected AT recurrence in adjusted time-to-event analysis (OR 0.46 (0.26-0.82), p=0.009).

conclusionsIn this real-world cohort, PFA was associated with a higher rate of acute PWI and greater freedom from AT compared with RFA, without a signal of increased complications. Prospective randomised studies are needed to define the role of PWI delivered with PFA in patients with persistent AF, including those with reduced LVEF.

Indexed as

Atrial FibrillationCatheter AblationHeart AtriaPulmonary VeinsAction PotentialsAgedAtrial Function, LeftFemaleHeart RateHumansIrreversible Electroporation TherapyMaleMiddle AgedRecurrenceRetrospective StudiesRisk FactorsAblation TechniquesAtrial FibrillationElectrophysiology

Identifiers

PMID41638753
PMCPMC12878311

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.