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Variable Loop Circular Catheter Pulsed Field Ablation in Real-World Practice: Low Complication Rates Across Patient and Procedural Characteristics in the REAL AF Registry
Journal article   Open access   Peer reviewed

Variable Loop Circular Catheter Pulsed Field Ablation in Real-World Practice: Low Complication Rates Across Patient and Procedural Characteristics in the REAL AF Registry

Christopher Porterfield, Paari Dominic, Yaariv Khaykin, Aleem Mughal, Sean Mazer, Muhammad Ali Jazayeri, Matthew Ebinger, Macy Smith, Anil Rajendra, Joshua Greenberg, …
Heart rhythm
04/24/2026
DOI: 10.1016/j.hrthm.2026.04.022
PMID: 42035937
url
https://doi.org/10.1016/j.hrthm.2026.04.022View
Published (Version of record) Open Access

Abstract

Pulsed field ablation (PFA) using a variable loop circular catheter (VLCC) is increasingly adopted for atrial fibrillation (AF) ablation. Early experience suggests a favorable safety profile, yet outcomes from complex procedures remain limited. To evaluate the safety profile of the VLCC from a large, multicenter, real-world registry. Consecutive ablations performed with the VLCC in the prospective, multicenter REAL AF registry were evaluated for safety events through 3 months follow-up. Events were categorized by investigator-assessed relationship to procedure and/or VLCC. In 1,014 index ablation cases, the procedure-attributed complication rate was 0.6% (6/1,014). Complications included: cardiac tamponade/pericardial effusion attributed to a concomitant left atrial appendage closure device, sinoatrial block following accessory pathway ablation, iliac artery dissection, fluid overload, blurred vision with normal magnetic resonance imaging (MRI), and transient ischemic attack. Half of events occurred in cases involving adjunctive RFA. No strokes, coronary spasm, or deaths were reported. Complication rates were low in all AF types and ablation strategies. Same-day discharge occurred in 86.5% of cases, and acute pulmonary vein isolation was achieved in 99.6%. In a multicenter real-world cohort that included persistent AF and more complex strategies, the VLCC demonstrated a favorable early safety profile with no catheter-attributed adverse events and very low procedure-attributed complications. These findings support the feasibility of efficient, outpatient-focused PFA workflows while ongoing accrual will enable more granular assessment of rare events. [Display omitted]
 and atrial fibrillation pulsed field ablation REAL AF variable loop circular catheter VARIPULSE

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