Introduction
While pulsed-field ablation (PFA) and radiofrequency ablation (RFA) are effective treatments for atrial fibrillation (AF), predictors of long-term sinus rhythm (SR) maintenance remain unclear. We aimed to identify clinical predictors of 12-month SR maintenance after AF ablation using PFA or RFA.
Methods
In a prospective cohort of 386 patients (260 PFA, 126 RFA) treated between January 2023 and December 2024, logistic regression was used to assess predictors of 12-month SR maintenance. Follow-up included outpatient visits and 24-h Holter monitoring at 6 and 12 months. Variables significant in univariate analysis were included in multivariate models, which were constructed for the entire cohort and for PFA and RFA subgroups.
Results
In the overall cohort, higher age (OR 0.96; p = 0.007), higher weight (OR 0.97; p = 0.003) and persistent AF (OR 0.50; p = 0.03) were associated with lower SR maintenance (AUC 0.73). In the PFA subgroup, higher age and weight remained significant predictors (AUC 0.79). In the RFA subgroup, persistent AF (OR 0.41; p = 0.04) and beta-blocker use (OR 2.98; p = 0.02) were associated with outcomes (AUC 0.69).
Conclusion
Age, weight and AF type are key predictors of AF recurrence after catheter ablation. Predictive performance was higher in PFA-treated patients, supporting the need for modality-specific risk stratification.
