{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:01:53Z","timestamp":1791345713108,"version":"4.3.1"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Beginning in September 2024, three large\u2010footprint pulsed\u2010field ablation (PFA) systems were introduced in Japan for atrial fibrillation (AF) ablation.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare acute procedural outcomes and safety profiles between PFA and thermal ablation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This multi\u2010center observational study included 4969 consecutive index AF ablation procedures (69\u2009\u00b1\u200911 years, 1495 women, 2705 paroxysmal) performed between January 2024 and July 2025. Among them, 2817 and 2152 procedures were performed with thermal ablation and PFA (FARAPULSE 53.3%, PulseSelect 41.3%, and VARIPULSE 5.5%), respectively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n PFA procedures were performed under deeper sedation (70.5% deep sedation) compared with thermal ablation. The total PFA application numbers were 50\u2009\u00b1\u200913 for FARAPULSE, 49\u2009\u00b1\u200913 for PulseSelect, and 24\u2009\u00b1\u20098.5 for VARIPULSE. Touch\u2010up ablation for pulmonary veins was more frequently required with balloon\u2010based thermal ablation than with PFA (7.2% vs. 1.5%,\n p<\/jats:italic>\n \u2009<\u20090.01). Adjunctive posterior wall isolation was more common in the PFA\u2010group than Thermal\u2010group (30.3% vs. 11.4%,\n p<\/jats:italic>\n \u2009<\u20090.01). Fluoroscopy time was significantly longer (27.8\u2009\u00b1\u200917.1 vs. 24.9\u2009\u00b1\u200917.6\u2009min,\n p<\/jats:italic>\n \u2009<\u20090.01) and total procedure time significantly shorter in the PFA\u2010group than Thermal\u2010group (106\u2009\u00b1\u200948.5 vs. 131\u2009\u00b1\u200954.4\u2009min,\n p<\/jats:italic>\n \u2009<\u20090.01). The overall complication rate (2.4% vs. 4.4%,\n p<\/jats:italic>\n \u2009<\u20090.01) and phrenic nerve palsy rate (0.1% vs. 1.5%,\n p<\/jats:italic>\n \u2009<\u20090.01) were significantly lower, while coronary spasms tended to be more frequent in the PFA\u2010group. No gastric hypomotility or pericarditis occurred in the PFA\u2010group despite much lower use of esophageal temperature monitoring (3.2% vs. 83.1%,\n p<\/jats:italic>\n \u2009<\u20090.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This large real\u2010world registry demonstrated a significantly lower incidence of procedure\u2010related complications with large\u2010footprint PFA devices compared with thermal ablation systems, despite early\u2010phase adoption.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jce.70474","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T14:53:12Z","timestamp":1785941592000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Analysis of Safety Profiles of Pulsed Field and Thermal Energy Atrial Fibrillation Ablation: Insight From the Multicenter Real\u2010World Ablation Registry"],"prefix":"10.1111","author":[{"given":"Osamu","family":"Inaba","sequence":"first","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Saitama Hospital Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0230-0934","authenticated-orcid":false,"given":"Shinsuke","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Institute of Science Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Nitta","sequence":"additional","affiliation":[{"name":"Department of Cardiology Sakakibara Heart Institute Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokosuka Kyosai Hospital Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Cardiology NHO Disaster Medical Center Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutoshi","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Iwai","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hiratsuka Kyosai Hospital Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihide","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Shin\u2010yurigaoka General Hospital Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4661-2999","authenticated-orcid":false,"given":"Yasuteru","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Yokohama City Bay Hospital Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8193-6617","authenticated-orcid":false,"given":"Akira","family":"Mizukami","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kameda Medical Center Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Hachiya","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Cardiology Tokyo Yamate Medical Center Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Sakakibara Heart Institute Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Negishi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Institute of Science Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuo","family":"Sasano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Institute of Science Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae043","article-title":"2024 European Heart Rhythm Association\/Heart Rhythm Society\/Asia Pacific Heart Rhythm Society\/Latin American Heart Rhythm 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Primer on Pulsed Electrical Field Ablation: Understanding the Benefits and Limitations","volume":"14","author":"Verma A.","year":"2021","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.hrthm.2019.01.012","article-title":"Pulsed Electric Fields for Cardiac Ablation and Beyond: A State\u2010of\u2010the\u2010Art Review","volume":"16","author":"Maor E.","year":"2019","journal-title":"Heart Rhythm"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1146\/annurev-biophys-052118-115451","article-title":"Membrane Electroporation and Electropermeabilization: Mechanisms and Models","volume":"48","author":"Kotnik T.","year":"2019","journal-title":"Annual Review of Biophysics"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1056\/NEJMoa2307291","article-title":"Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation","volume":"389","author":"Reddy V. Y.","year":"2023","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1038\/s41591-024-03114-3","article-title":"Safety of Pulsed Field Ablation in More Than 17,000 Patients With Atrial Fibrillation in the MANIFEST\u201017K Study","volume":"30","author":"Ekanem E.","year":"2024","journal-title":"Nature Medicine"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1161\/CIRCULATIONAHA.123.063988","article-title":"Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial","volume":"147","author":"Verma A.","year":"2023","journal-title":"Circulation"},{"key":"e_1_2_10_11_1","article-title":"Predictors of Success for Pulmonary Vein Isolation With Pulsed\u2010Field Ablation Using a Variable\u2010Loop Catheter With 3D Mapping Integration: Complete 12\u2010month Outcomes From InspIRE","volume":"17","author":"De Potter T.","year":"2024","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","DOI":"10.1002\/joa3.13182","article-title":"Real\u2010World Clinical Practice of Current Periprocedural Anticoagulation Management in Catheter Ablation of Atrial Fibrillation: Data From a Large Prospective Ablation Registry","volume":"41","author":"Taomoto Y.","year":"2025","journal-title":"Journal of Arrhythmia"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae092","article-title":"Incidence of Phrenic Nerve Injury During Pulmonary Vein Isolation Using Different Cryoballoons: Data From a Large Prospective Ablation Registry","volume":"26","author":"Tachibana S.","year":"2024","journal-title":"Europace"},{"key":"e_1_2_10_14_1","first-page":"604","article-title":"Real\u2010World Safety Profile of Atrial Fibrillation Ablation Using a Second\u2010Generation Cryoballoon in Japan","volume":"7","author":"Miyazaki S.","year":"2021","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"8","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1038\/s41591-024-03022-6","article-title":"Dual\u2010Energy Lattice\u2010Tip Ablation System for Persistent Atrial Fibrillation: A Randomized Trial","volume":"30","author":"Anter E.","year":"2024","journal-title":"Nature Medicine"},{"issue":"3","key":"e_1_2_10_16_1","article-title":"Symptomatic Gastroparesis After Cryoballoon\u2010Based Atrial Fibrillation Ablation: Results From a Large Multicenter Registry","volume":"16","author":"Miyazaki S.","year":"2023","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_10_17_1","first-page":"628","article-title":"Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation","volume":"9","author":"Aryana A.","year":"2023","journal-title":"JACC: Clinical Electrophysiology"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/jama.2022.23722","article-title":"Effect of Catheter Ablation Using Pulmonary Vein Isolation With Vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA Randomized Clinical Trial","volume":"329","author":"Kistler P. 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