ArticleJournal of cardiovascular electrophysiology2026
Patient-Reported Outcome Measures Following Pulsed-Field Ablation Versus Thermal Ablation of Atrial Fibrillation: The PROMs-PFA Study.
Article in Journal of cardiovascular electrophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPulsed-field ablation (PFA) has transformed atrial fibrillation (AF) ablation, but how the early patient experience compares with thermal techniques remains unclear. This study aimed to assess patient-reported outcome measures (PROMs) in the first 3 months after PFA or thermal AF ablation, using a novel smartphone-based application.
methodsPatients undergoing first-time pulmonary vein isolation prospectively completed the Cardiac Ablation Recovery Evaluation (CARE) symptom questionnaire at five timepoints: baseline, day 1, day 7, day 30, and day 90. Symptoms were rated on a 7-point Likert scale (0 = not at all; 6 = extremely). Patients also completed the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire at baseline and day 90.
resultsTwo hundred and two patients were included (pentaspline PFA: 66; radiofrequency: 64; cryoballoon: 72), with similar baseline demographics between groups, except for a lower prevalence of paroxysmal AF in the PFA group. Engagement with the smartphone-based platform was high, with a 94.7% completion rate. Median AFEQT scores improved from 64 (47-82) at baseline to 86 (72-95) at day 90 (p < 0.001), with no significant differences between modalities (p = 0.841). However, CARE detected differences in early symptom experience: chest pain was lowest with PFA at day 1 (median: PFA, 1 [0-2]; radiofrequency, 2 [1-2]; cryoballoon, 2 [1-2]; p < 0.001), and remained lower than cryoballoon at day 7 (p = 0.019), with differences resolving by day 30. Moderate-to-severe chest pain (score ≥ 3) occurred in only 12.3% of PFA patients at day 1, compared with 21.2% cryoballoon and 26.2% radiofrequency patients (p < 0.001). Palpitations at day 1 were less frequent with PFA than radiofrequency (p = 0.040). Groin discomfort was lower with radiofrequency than PFA or cryoballoon at day 1 (p = 0.006) and day 7 (p < 0.001), likely reflecting a smaller sheath size.
conclusionsPFA was associated with a modest and transient reduction in early post-procedural chest pain compared with thermal ablation. Smartphone application-based PROMs collection using the CARE questionnaire was feasible, enabling structured assessment of symptom burden across multiple recovery timepoints.
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