{"id":"9e0598b3bd29","type":"article","url":"https://hartvaat.nl/2026/09/27/pfa-toont-superieure-veiligheid-en-betere-uitkomsten-na-af-ablatie-pol-ar/","title":"PFA toont superieure veiligheid en betere uitkomsten na AF-ablatie — POL-AR","title_en":"Pulsed Field Ablation Is Associated With Favorable Outcomes After Atrial Fibrillation Ablation: Insights From the Polish National Ablation Registry (POL-AR).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of cardiovascular electrophysiology","doi":"10.1111/jce.70514","source_url":"https://doi.org/10.1111/jce.70514","authors":["Piotr Urbanek","Robert Bodalski","Michał Orczykowski","Ilona Kowalik","Andrzej Głowniak","Piotr Ponikowski","Oskar Kowalski","Paweł Derejko","Mariusz Pytkowski","Łukasz Szumowski"],"significance":6,"published":"2026-10-04","source_date":"2026-09-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"The prospective POL-AR national registry compared 1-year outcomes of radiofrequency, cryoballoon, and pulsed field ablation (PFA) in 3,430 patients with atrial fibrillation. PFA was associated with the shortest procedure times (median 65 min), zero major complications, and no phrenic nerve injuries, outperforming radiofrequency (2.19% complications, 0.09% nerve injury) and cryoballoon. Patients treated with PFA also required fewer repeat cardioversions and had an independent association with favorable 1-year outcomes (HR 0.70; p=0.04). These real-world findings reinforce the safety profile of PFA and support its expanding role in contemporary arrhythmia management.","created":"2026-09-28T00:58:54Z","updated":"2026-09-28T00:58:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In het prospectieve nationale POL-AR-register werden 3430 patiënten met atriumfibrilleren vergeleken die een ablatie ondergingen met radiofrequentie, cryoballoon of pulsed field ablation (PFA). PFA ging gepaard met de kortste procedureduur (65 min), een nihil percentage ernstige complicaties en 0% frenaal zenuwletsel, in contrast met respectievelijk 2,19% en 0,09% bij radiofrequentie. PFA-patiënten hadden bovendien minder hercardioversies nodig en een onafhankelijk geassocieerd voordeel in de 1-jaarsuitkomst (HR 0,70; p=0,04). Deze real-world data bevestigen het gunstige veiligheidsprofiel van PFA en ondersteunen de groeiende adoptie van deze technologie in de elektrofysiologische praktijk.","abstract_original":"BACKGROUND: The Polish National Ablation Registry (POL-AR), mandatory for all centers performing catheter ablation and integrated with National Health Fund data, enables prospective analysis of a nationwide cohort with complete inclusion of all consecutive patients. OBJECTIVE: We aimed to assess real-world safety profiles and clinical outcomes of atrial fibrillation (AF) ablation modalities-radiofrequency (RF), cryoballoon (CRYO), and pulsed-field ablation (PFA)-and to report the first-year PFA experience in Poland. METHODS: All AF ablations in 2023 were prospectively analyzed in POL-AR and cross-referenced with National Health Fund data. Only centers with complete reporting were included. Patients were grouped by modality. Major complications, unplanned hospitalizations, cardioversions, repeat ablations, and deaths were assessed at 1 year. Multivariate analysis identified independent predictors of outcomes. RESULTS: Twenty-eight centers reported 3430 patients (CRYO: 2125; RF: 1098; PFA: 207). Procedure time was longest for RF (median 120 min) versus CRYO (75 min) and PFA (65 min); (p < 0.001). No major complications occurred with PFA. Phrenic nerve injury persisted in 1.51% of CRYO, 0.09% of RF, and 0% of PFA patients (p < 0.001). Pericardial effusion was more frequent after RF (0.91% vs. 0.34% for CRYO + PFA; p = 0.032). Overall complication rates were lowest with PFA (0% vs. RF: 2.19%, CRYO: 2.59%). PFA patients required fewer cardioversions during follow-up (p = 0.017). Predictors of poor outcome included age, female sex, left atrium (LA) size, hypertension, and hypertrophic cardiomyopathy (HCM). Favorable outcome was independently associated with higher left ventricular ejection fraction (LVEF), paroxysmal AF, and PFA use (HR 0.70, p = 0.04). CONCLUSION: In the POL-AR registry, PFA was independently associated with favorable outcomes after AF ablation."}