Abstract Body (Do not enter title and authors here): Background:
Pulsed-field ablation (PFA) for atrial fibrillation (AF) offers several advantages compared to thermal ablation, however direct comparisons of patient-reported outcomes after PFA and radiofrequency ablation (RFA) are limited. This study aimed to assess patient experience following PFA or RFA in AF ablation performed under general anesthesia.

Methods:
A retrospective study across a single integrated health system was conducted on consecutive patients who underwent PFA or RFA for AF under general anesthesia. Data were collected from electronic medical records. Primary endpoints included postprocedural pain complaints and scores, need for post-procedure analgesic medication, and frequency of emergency department (ED) visits for procedure-related concerns.

Results:
Two hundred patients (100 PFA and 100 RFA) were analyzed (age 73.2 ±9.2y, 38% female). Patients undergoing RFA had a significantly higher rate of ED visits compared to those who underwent PFA (17% vs. 6%, p <.05) with common complaints of shortness of breath, chest pain, palpitations, and fatigue. There were no statistically significant differences in postprocedural pain scores (RFA 1.70 vs. PFA 1.57, p = 0.61), requests for analgesic medications in the recovery area (RFA 36% vs. PFA 27%, p = 0.26), nor encounters made to the care team within 4 weeks following the procedure (RFA 57% vs. PFA 44%, p = 0.20).

Conclusion:
In this retrospective study, patients undergoing PFA for AF under general anesthesia experienced fewer ED visits for procedure-related issues compared to those undergoing RFA. The increased rate of ED visits in the RFA group may be attributed to more extensive ablation beyond PVI or persistence of AF. While these clinical endpoints potentially suggest improved procedural recovery with PFA compared to RFA, larger prospective studies using patient-reported outcome measures are warranted.