Contemporary pulsed field ablation workflows in Europe: real-world procedural strategies for paroxysmal and persistent atrial fibrillation in the FARAWAY registry
S Tzeis, A Rossillo, K Schmidt, B Pierre, M Bertini, M Rivero-Ayerza, P Penafiel, M Wolf, R Maggio, L Alvarez-Acosta, J M Herzet, E Rodriguez, M Martinek, F Bokhari, N Basterra-SolaAbstract
Background
Pulsed field ablation (PFA) has rapidly emerged as a safe and effective alternative to thermal ablation for atrial fibrillation (AF), leading to widespread global adoption. However, clinical uptake has outpaced detailed reporting on real-world use of the pentaspline PFA system, leaving key gaps in our understanding including how procedural workflows differ by AF indication.
Purpose
To characterize contemporary PFA workflows in European centers and compare procedural strategies for paroxysmal AF (PAF) versus persistent AF (PersAF).
Methods
FARAWAY is a prospective, observational sub-protocol of the FARAVERSE global registry, evaluating clinical experience with the pentaspline PFA system. Informed consent was obtained, and procedures were performed as per standard of care. Enrollment is still ongoing, procedural characteristics and acute safety data were analyzed in an interim cut based on AF indication.
Results
Procedural data were collected for 262 patients (mean age 64.2 ± 10.3 years; 37.3% female; 65.2% PAF and 34.8% PersAF) from 14 centers in 7 European countries. Pulmonary vein isolation (PVI) was performed in all patients using PFA. In 49 patients (18.7%), additional substrates were targeted including the posterior wall (PW; n=33) and cavotricuspid isthmus (n=18). PVI-only strategies were more common in PAF than PersAF (91.2% vs. 68.8%, p<0.001), while the number of PV applications did not differ. PW ablation occurred in 4.7% of PAF patients versus 27.5% of PersAF patients (p<0.001). A PersAF indication was also associated with longer procedure time (57±24 vs. 51±24 min, p=0.023; Fig 1A), left atrial dwell time (32±11 vs. 27±11 min, p<0.001; Fig 1B), without a significant difference in fluoroscopy time (Fig 1C) or intracardiac echocardiography (ICE) use (Fig 1D) as compared to PAF. The rate of 3D electroanatomical mapping use was 2.8 times higher in PersAF cases as compared to PAF cases (18.8% vs. 6.7%, p=0.005; Fig 1D). No cases reported using a combination of ICE and mapping. Acute procedural safety was uniformly high across indications. No hemolysis, symptomatic cerebrovascular incidents, or phrenic nerve injury were reported.
Conclusions
In this real-world multicenter registry, the pentaspline PFA system demonstrated efficient and safe ablation for both PAF and PersAF patients. This interim analysis reveals indication-driven workflows, with simplified PAF strategies compared to PersAF. Full acute results will be presented at EHRA 2026.