Patient-Reported Outcome Measures Following Pulsed-Field Ablation Versus Thermal Ablation of Atrial Fibrillation: The PROMs-PFA Study

Mark T Mills; Peter Calvert; Keith Wilson; Zoltan Borbas; Richard Snowdon; Saagar N Mahida; Reza Ashrafi; Johan Waktare; Simon Modi; Derick Todd; Nathan Denham; Vishal Luther; Dhiraj Gupta

doi:10.1111/jce.70392

Patient-Reported Outcome Measures Following Pulsed-Field Ablation Versus Thermal Ablation of Atrial Fibrillation: The PROMs-PFA Study

J Cardiovasc Electrophysiol. 2026 Jun 9. doi: 10.1111/jce.70392. Online ahead of print.

Authors

Mark T Mills^{1

2

3}, Peter Calvert^{1

2}, Keith Wilson⁴, Zoltan Borbas¹, Richard Snowdon¹, Saagar N Mahida¹, Reza Ashrafi¹, Johan Waktare¹, Simon Modi¹, Derick Todd¹, Nathan Denham¹, Vishal Luther^{1

2}, Dhiraj Gupta^{1

2}

Affiliations

¹ Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, Merseyside, UK.
² Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, Merseyside, UK.
³ Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK.
⁴ Research Department, Liverpool Heart & Chest Hospital, Liverpool, Merseyside, UK.

PMID: 42262263
DOI: 10.1111/jce.70392

Abstract

Background: Pulsed-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.

Methods: Patients 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.

Results: Two 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.

Conclusions: PFA 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.

Keywords: atrial fibrillation; catheter ablation; electroporation; patient‐reported outcome measures; pulmonary vein isolation; pulsed‐field ablation; symptoms.