Comparison of Different Pulsed Field Ablation Catheters in Atrial Fibrillation

Inclusion criteria

• Older than 18 years.
• Diagnosed with drug-refractory, symptomatic atrial fibrillation.
• The patient has a high risk of stroke (CHA2DS2-VA score ≥ 2).
• Have a situation of:

• requires oral anticoagulation therapy
• high bleeding risk (HAS-BLED score ≥ 3) that unsuitable for or unwilling to undergo long-term oral anticoagulation therapy.
• Subjects are able to understand the purpose of the study, voluntarily participate in the study and sign the informed consent, and are willing to complete the follow-up according to the requirements of the program.

Exclusion criteria

• History of persistent atrial fibrillation >1 year.
• Atrial fibrillation was secondary to thyroid disease or other reversible reasons.
• Left atrial anteroposterior diameter >50 mm.
• Evidence of left atrial or left atrial appendage thrombus on imaging examination.
• Concurrent other arrhythmias required for catheter ablation (e.g., atrioventricular reentrant tachycardia, atrioventricular nodal reentrant tachycardia, pre-excitation syndrome) prior to enrollment.
• Rheumatic heart disease.
• Left ventricular ejection fraction <40% or New York Heart Association (NYHA) class III/IV.
• Unstable angina.
• Myocardial infarction (MI), coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI) within 3 months prior to enrollment.
• History of prior left atrial appendage closure, patent foramen ovale closure, atrial septal defect closure, or repair surgery.
• Implantation of a mechanical mitral valve prosthesis or metallic annuloplasty rings.
• Presence of intracardiac thrombus, space-occupying lesions, or other abnormalities that preclude vascular access or catheter manipulation.
• Contraindications to anticoagulation or history of coagulation disorders/abnormal bleeding.
• Active systemic infection.
• Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² or history of renal dialysis.
• Pregnancy or breastfeeding.
• Life expectancy <12 months (e.g., advanced malignancy).
• Current or anticipated participation in other drug or device clinical trials.
• Any other condition or abnormality deemed by the investigator to warrant exclusion.