{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:12:17Z","timestamp":1793211137692,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","funder":[{"name":"Boston Scientific, Inc."}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy. Examination of real-world data may shed light on clinical practices and the effectiveness of PFA with and without a prior history of AAD usage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>European Real World Outcomes with Pulsed Field Ablation is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at 7 high-volume centers in Europe. This subanalysis evaluates patients with a history of class I\/III AAD use versus those with no documented history of class I\/III AAD use (first-line patients). Patients with incomplete AAD history, long-standing persistent AF, and those undergoing a repeat ablation procedure were excluded. Patients were treated and followed based on institutional standard of care. Any episode of atrial tachycardia or AF lasting longer than 30 s was considered an arrhythmia recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 1233 patients enrolled in European real world outcomes with pulsed field ablation, 1091 met the inclusion criteria (mean age, 66 years; 40% females; and persistent AF, 36%). Pulmonary vein isolation-only was used in 90% of the patients, and 10% received extra-PV ablation. Ablation as the first-line approach was chosen in 589 patients, and 502 patients had prior class I\/III AAD use. In the first-line PFA group, paroxysmal AF was more frequent (68% versus 59%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), and pulmonary vein isolation-only was more frequent (93% versus 86%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). At 1-year follow-up, freedom from AF\/atrial tachycardia recurrence was similar in the ablation-first versus the ablation after failed AAD group (78% versus 74%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.076).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>In this large real-world PFA registry, freedom from AF\/atrial tachycardia recurrence after 1 year was similar in patients undergoing PFA as a first-line treatment and those with prior failed AAD therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT05823818.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.124.013088","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T05:01:23Z","timestamp":1732683683000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Pulsed Field Ablation as First-Line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry"],"prefix":"10.1161","volume":"17","clinical-trial-number":[{"clinical-trial-number":"nct05823818","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2116-1690","authenticated-orcid":true,"given":"Anna","family":"F\u00fcting","sequence":"first","affiliation":[{"name":"Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.)."},{"name":"Department of Medicine, Witten\/Herdecke University, Germany (A.F., K.N., N.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2075-8113","authenticated-orcid":true,"given":"Kars","family":"Neven","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.)."},{"name":"Department of Medicine, Witten\/Herdecke University, Germany (A.F., K.N., N.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0282-4658","authenticated-orcid":true,"given":"Stefano","family":"Bordignon","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (S. Bordignon, K.R.J.C., B. Schmidt)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7197-8415","authenticated-orcid":true,"given":"Tobias","family":"Reichlin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuri","family":"Blaauw","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (Y.B., B.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6600-9006","authenticated-orcid":true,"given":"Jim","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Arrhythmia Unit, Gentofte Hospital, Copenhagen, Denmark (J.H., M.H.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8843-9370","authenticated-orcid":true,"given":"Raquel","family":"Adelino","sequence":"additional","affiliation":[{"name":"Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7405-822X","authenticated-orcid":true,"given":"Alexandre","family":"Ouss","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center Catharina Hospital, Eindhoven, the Netherlands (A.O., P.v.d.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0827-1329","authenticated-orcid":true,"given":"Laurent","family":"Roten","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4411-3918","authenticated-orcid":true,"given":"Bart A.","family":"Mulder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (Y.B., B.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin H.","family":"Ruwald","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Arrhythmia Unit, Gentofte Hospital, Copenhagen, Denmark (J.H., M.H.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1671-1977","authenticated-orcid":true,"given":"Roberto","family":"Men\u00e9","sequence":"additional","affiliation":[{"name":"Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0927-3406","authenticated-orcid":true,"given":"Pepijn","family":"van der Voort","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center Catharina Hospital, Eindhoven, the Netherlands (A.O., P.v.d.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7385-2691","authenticated-orcid":true,"given":"Nico","family":"Reinsch","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.)."},{"name":"Department of Medicine, Witten\/Herdecke University, Germany (A.F., K.N., N.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3553-4945","authenticated-orcid":true,"given":"Thomas","family":"Kueffer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-7042","authenticated-orcid":true,"given":"Serge","family":"Boveda","sequence":"additional","affiliation":[{"name":"Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. 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