A single centre experience of pulsed field ablation for atrial fibrillation using the Medtronic PulseSelect System: an analysis of the first 100 patients.

BACKGROUND

Pulsed Field Ablation (PFA) has been rapidly adopted as a method of Pulmonary Vein Isolation (PVI) for patients with atrial fibrillation (AF). As a non-thermal, tissue-selective technique it may reduce or eliminate some of the complications observed with radiofrequency or cryo-ablation including oesophageal fistula formation and phrenic nerve palsy. It appears to be as efficacious and safer than thermal based ablations. We evaluated the first 100 patients who underwent ablation using the PulseSelect PFA system (Medtronic, Minneapolis, USA) at our centre.

METHODS

All patients who underwent AF ablation using the PulseSelect PFA system between May 2024 and February 2025 were identified from our local, prospective registry. Primary outcome was successful intra-procedural PVI. Secondary outcomes included adverse events, procedure duration, fluoroscopy time and same-day discharge.

RESULTS

All of the patients achieved PVI. Additional non-PV target ablations were performed in 39 patients (22 radiofrequency CTI line ablations, 18 other targets). Five (5%) had procedural complications, two of which related to vascular access. Median procedural time was 85 min for all procedures, and 70 min for PVI-only, with improved times as user experience increased. Median fluoroscopy time was 20 min. Same-day discharge was achieved in 49 patients.

CONCLUSION

PFA using Medtronic's PulseSelect System is an effective and safe method of achieving PVI. Our data would suggest it is a quicker procedure than thermal based ablation, which rapidly improved with user experience. The long-term durability of PVI requires further follow-up.