Long-Term Cardiovascular Profiles and Safety of Pulsed Field Ablation Versus Cryoballoon Ablation in Paroxysmal Atrial Fibrillation

International Journal of Cardiology | Vol. 17, No. 8, August 2026 | pp. 33–40

DOI: 10.46882/2026/IJC/001917

Original Research Article

Long-Term Cardiovascular Profiles and Safety of Pulsed Field Ablation Versus Cryoballoon Ablation in Paroxysmal Atrial Fibrillation

Pierre Dubois¹, Jean-Luc Moreau¹

¹ Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France

Abstract:
Pulsed field ablation (PFA) utilizes non-thermal tissue-selective electroporation to isolate pulmonary veins, offering a theoretical safety advantage over conventional thermal techniques. This multi-center prospective cohort study compared the 12-month clinical efficacy and safety profiles of PFA versus cryoballoon ablation (CBA) in patients with drug-refractory paroxysmal atrial fibrillation (AF). We evaluated 450 patients undergoing catheter ablation, with 225 assigned to PFA and 225 to CBA. The primary efficacy endpoint was freedom from documented atrial tachyarrhythmias lasting longer than 30 seconds at 12 months, excluding a 3-month blanking period. The primary safety endpoint was a composite of major procedure-related complications. At 1 year, the rate of freedom from recurrent atrial tachyarrhythmias was comparable between the two cohorts (79.1% in the PFA arm vs. 76.4% in the CBA arm, p = 0.48). However, the PFA group displayed a significantly shorter total procedure duration (42.5 ± 8.2 minutes vs. 68.4 ± 12.5 minutes, p < 0.001) and total fluoroscopy time (6.2 ± 1.8 minutes vs. 13.4 ± 3.2 minutes, p < 0.01). The primary safety endpoint occurred in 1.3% of the PFA group compared to 4.4% of the CBA group (p = 0.04), driven by a complete absence of phrenic nerve injury or pulmonary vein stenosis in the PFA cohort. Non-thermal PFA delivers equivalent long-term anti-arrhythmic efficacy to cryoballoon ablation while significantly improving procedural efficiency and lowering complication rates.

Keywords: Atrial fibrillation, Pulsed field ablation, Cryoballoon ablation, Electroporation, Pulmonary vein isolation, Catheter ablation safety

Received: May 18, 2026; Revised: June 22, 2026; Accepted: July 08, 2026; Published: August 12, 2026

Citation: Dubois P, Moreau J. Long-Term Cardiovascular Profiles and Safety of Pulsed Field Ablation Versus Cryoballoon Ablation in Paroxysmal Atrial Fibrillation. International Journal of Cardiology, 2026; 17(8): 33–40. DOI: 10.46882/2026/IJC/001917

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