Any comments on post PFA procedures?

Aferra is better than Farapulse is what I hear

Just as an interested reader who has had two RF ablations, and no history or experience with PFA:

As of last summer, I read a research paper saying that PFA currently enjoys no statistically significant improvement over RF or cryo ablations across practitioners (but we know that the expertise and experience of the practitioner EP counts a great deal and is the genesis of the variance we see from patient to patient). The one great benefit of PFA is that it offers less risk of collateral damage to tissues near the application. This means the patient doesn't normally need a TEE (trans-esophageal echocardiogram) while sedated and the procedure is being done. The one detractor is that PFA requires more exposure to fluoroscopy, which is not innocuous.

It is likely that a simple PVI (pulmonary vein isolation) is not going to cut it this time. This would have been done the first time for certain, perhaps with some 'mapping' to nip one or two other nearby sites. Now, years later (buy that first EP a good bottle of scotch!), your disease has progressed and you need yet another intervention. Except, now you have even more sites showing electrical activity that wants to begin taking over the heart's rhythm. This means the EP you call on to do this second ablation is going to have to be capable of, and confident of, locating and isolated/ablating the diseased tissue somewhere else....maybe the coronary sinus, maybe the LAA (left atrial appendage), maybe it's pericardial this time, maybe the mitral valve annulus, or it could be in the septum between the two atria....take yer best guess. It might even have established itself in the Vein of Marshal, which requires cryo application and is a different procedure (they can use special fluids or even very cold saline that isn't quite frozen).

As for recovery and how you're likely to feel after a PFA, about the only difference is going to be how your heart responds to the new areas treated, but also if you haven't had a TEE it will be less likely you'll have a sore/parched throat when you awaken...as I had. So, with very high probability, barring something unusual, you will likely feel no worse than the previous time, and probably somewhat better. How you do with recovery, and how quickly you get your mojo back and want to resume normality, is another matter. Only time will tell.

Had a PFA (Farapulse) for paroxysmal Afib and RFA for Aflutter. under GA in February of 2026. and was kept overnight. The EP said it went well and according to plan; aside from a sore throat from the TEE, which revolved in a few days, it wasn't especially uncomfortable. Over the first week a fair amount of bruising and swelling in legs developed; that resolved over a few more weeks. For several weeks had generally a higher than normal resting HR, more PACs than I'm used to and reduced tolerance for exercise. Resting HR is now back to pre-ablation levels, and over the past month have regained the level of conditioning that I had prior to the procedure. So far (3 months out) I've had a handful of brief (a few minutes or less) of possible Afib and no Flutter, so I'm reasonably optimistic.

I had PFA in November of 2025 and have been A-fib free ever since! I had a few PAC's afterward about 3 weeks after the ablation that concerned me, but my cardiologist reassured me these were no big deal. I followed all the recommendations after the procedure, kept it low key for 10 days afterward, went back to the gym and worked my way up to my usual routine slowly and I am doing fine--actually great for 80 years old. I do a pretty vigorous workout daily and I am very happy with the results. My EP was wonderful--thorough and highly competent. Good luck and don't worry!

@sjm46 Was that your first ever ablation or a follow up? Thanks for the feedback

That was my first, and hopefully my last ablation! I was diagnosed in 2024 in October, had a cardioversion in December, then did well through the first half of 2025 until May, when I had three Afib episodes lasting a few hours before converting back to NSR. I told my cardiologist I wanted to see an EP after doing a lot of research online, watching YouTube presentations. I got the very best EP in my opinion and after a very brief trial on anti-arrhythmia med, I hated the thought of side effects and long term use (I gave it 5 days!) I requested an ablation, pulse field and had to wait for an opening but got the ablation in November, 2025 and have had no problems since. I also did every lifestyle change suggested--except changing my age! I am 80 years old, go to the gym every day for a very vigorous workout, lost some weight, try to eat right, take supplements like Magnesium and OTC statin (garlic and red yeast rice) and gave up all alcohol and excessive caffeine. My cardiologist is the best; sent me to an EP who was highly respected, listened to all my issues, did a very thorough procedure (not just a "cookie cutter" ablation that some clinics seem to do) and I followed every direction post-procedure so that I would maximize my chances of success. I wish you good luck. Make sure you ask all the questions you need to and that the EP covers all the bases when he is in there mapping the problem areas. I think the skill/experience of the EP is critical to best outcomes.