Association between early and late atrial tachyarrhythmia recurrences after pulsed field ablation for atrial fibrillation: A systematic review and meta-analysis

Background Pulsed field ablation (PFA) has emerged as a tissue-selective modality for atrial fibrillation (AF) ablation. Early recurrence of any atrial tachyarrhythmia (ERAT) during the blanking period is considered transient; however, its association with late recurrence of any atrial tachyarrhythmia (LRAT) remains unclear. Objective This meta-analysis aimed to elucidate the association between ERAT and LRAT after PFA for different blanking cutoffs. Methods A search of MEDLINE, Scopus, and Cochrane (up to January 12, 2026) identified observational or randomized studies of PFA with ≥1-year follow-up. Double independent study selection, data extraction, and quality assessment were performed. Random-effects frequentist models were used to pool odds ratios, hazard ratios, proportions, and diagnostic accuracy measures with 95% confidence intervals (CIs). Results Seven observational cohort studies (3003 patients) were analyzed. ERATs within 0-90 days were strongly associated with LRATs (odds ratio, 8.98; 95% CI, 5.61-14.37; I2 = 68%; 7 studies), without subgroup differences by AF type, use of event recorders, or PFA technology. The positive predictive value of ERATs was 0.66 (95% CI, 0.55-0.76; I2 = 75%; 7 studies) within 0-90 days, 0.73 (95% CI, 0.63-0.81; I2 = 23%; 3 studies) within 0-60 days, and 0.56 (95% CI, 0.16-0.90; I2 = 85%; 2 studies) within 0-30 days. ERATs within 0-90 days demonstrated high specificity (0.93; 95% CI, 0.90-0.95) and positive likelihood ratio (5.83; 95% CI, 4.09-8.32) for LRATs. Age, heart failure, and non-pulmonary vein ablation were significant effect modifiers in meta-regression analysis. Conclusion ERATs within 0-90 days and 0-60 days after PFA are robust LRAT predictors, whereas first-month ERATs remain insufficiently investigated. Further studies are required to define the optimal blanking period after PFA.