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Mumbai London AF Clinic

The evidence

Whatever the machine, it is safer in experienced hands.

What published research says about PFA, RFA, and the doctor holding the catheter. In plain English, with citations.

You may have been offered PFA, pulsed field ablation, because it is a newer way to treat atrial fibrillation. RFA, radiofrequency ablation, uses carefully controlled heat; PFA uses short electrical pulses instead. Both treat the same small areas of heart tissue that trigger AF.

In 2025, large trials directly comparing the two reported their results: PFA and RFA performed broadly comparably; the right choice depends on the patient.1

The volume effect

The number that does change your outcome.

Across published studies, one factor shows up again and again: how often the centre, and the doctor, performs the procedure.2

Major complication rates at lower-volume versus higher-volume centresA bar chart comparing 2.1% at lower-volume centres with 0.9% at higher-volume centres.0%Lower-volume centresunder 50 ablations a year0%Higher-volume centres300+ ablations a year
Major complication rates after AF ablation, by centre volume.2, 4 Published research consistently finds lower complication rates where more of these procedures are done.

Professor Gupta has performed over 300 a year, every year since 2009.3

What this means for you.

The right question is not “which technology?” It is “who is holding the catheter?” Professor Gupta offers both RFA and PFA, and chooses the right tool for each patient.

His numbers, in context.

0+

ablations a year, every year since 20093

<0%

published complication rate3

0+

procedures across his career

Selected publications

The work behind the numbers.

Peer-reviewed work on AF ablation, stroke prevention, and outcomes, from the journals that set the standard of care.

Clinical trial

Cost, efficiency, and outcomes of pulsed field ablation vs thermal ablation for atrial fibrillation

Compares newer pulsed-field ablation with traditional heat-based techniques, showing how technology choice affects procedure time, cost, and patient outcomes.

Gupta D, et al.Heart Rhythm · 2024
Read paper →
Review & editorial

Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal

A quarter-century review of how stroke prevention in AF has evolved, from blood thinners to ablation and left atrial appendage closure.

Gupta D, et al.Europace · 2023
Read paper →
Review & editorial

Contemporary management of persistent atrial fibrillation

A practical guide to treating persistent AF today: when to ablate, which energy to use, and how to reduce the chance of the rhythm returning.

Gupta D, et al.Heart · 2022
Read paper →
Original research

COnCOmitaNt pulsed field ablation-based pUlmonary vein isolation and lefT atrial appendage closure: the COCONUT study

The largest study so far of pulsed-field ablation and appendage closure done in one sitting: 155 patients across 22 European centres, a 97% success rate, a 1.9% serious complication rate, and an average procedure time of 80 minutes.

Gupta D, et al.Europace · 2026
Read paper →
Original research

Predictors of pacing-induced cardiomyopathy in patients undergoing AV nodal ablation: insights from a Delphi process and retrospective cohort study

Liverpool data on 323 patients showing which people are most likely to develop a weakened heart from standard pacing after AV node ablation, so that they can be offered a more physiological pacing system up front.

Gupta D, et al.European Heart Journal Open · 2026
Read paper →
Original research

Impact of pulsed-field ablation on the left atrial appendage diameter: insights from intra-procedural echocardiography

Measures the left atrial appendage before and after pulsed-field ablation, showing the pouch size does not change, which matters when ablation and LAAO are planned together.

Gupta D, et al.Journal of Cardiovascular Electrophysiology · 2025
Read paper →
Review & editorial

Impact of pulmonary vein isolation on atrial arrhythmias in patients with typical atrial flutter: systematic review and meta-analysis of randomized clinical trials

Pools seven randomised trials, 902 patients in all, and finds that isolating the pulmonary veins alongside or instead of the standard flutter ablation roughly halves later atrial arrhythmias, mostly by preventing new AF.

Gupta D, et al.European Heart Journal Open · 2025
Read paper →
Review & editorial

Concurrent percutaneous left atrial appendage occlusion and catheter ablation for atrial fibrillation: state-of-the-art review

Reviews when AF ablation and LAAO can be done in the same sitting, how the two procedures are sequenced, and what blood-thinning looks like afterwards.

Gupta D, et al.Trends in Cardiovascular Medicine · 2024
Read paper →
Clinical trial

Cryoballoon pulmonary vein isolation as first-line treatment of typical atrial flutter: long-term outcomes of the CRAFT trial

Follows the CRAFT trial patients to three years. Freezing the pulmonary veins controlled flutter as well as the standard ablation did, and led to less atrial fibrillation afterwards.

Gupta D, et al.Journal of Interventional Cardiac Electrophysiology · 2024
Read paper →
Review & editorial

Intranasal etripamil for rapid treatment of paroxysmal supraventricular tachycardia

Reviews etripamil, a nasal spray being developed so that people can stop an episode of SVT themselves without an emergency visit, and where it might fit alongside ablation.

Gupta D, et al.Future Cardiology · 2024
Read paper →
Guideline

Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias: a scientific statement of EHRA, HRS, APHRS and LAHRS

The joint European, American, Asia-Pacific and Latin American position on cardioneuroablation as an alternative to a pacemaker for reflex fainting and nerve-driven slow rhythms: who it suits and how it should be done.

Gupta D, et al.Europace · 2024
Read paper →
Guideline

Left atrial appendage occlusion: British Cardiovascular Intervention Society and British Heart Rhythm Society position statement

The British position statement setting out who should be offered LAAO, how the procedure should be planned and performed, and the minimum experience an implanting centre and doctor should have.

Gupta D, et al.Interventional Cardiology · 2024
Read paper →
Review & editorial

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review

Reviews the small brain changes sometimes seen on scans after AF ablation: what they mean, how common they are, and how to minimise risk.

Gupta D, et al.Europace · 2023
Read paper →
Original research

Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure

Tracks how often clots form on or around LAAO devices over time, and which patients need longer blood-thinning after the procedure.

Gupta D, et al.JACC: Cardiovascular Interventions · 2023
Read paper →
Original research

Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent AF

Uses heart imaging to predict which persistent-AF patients are most likely to stay in normal rhythm after ablation.

Gupta D, et al.Circulation: Cardiovascular Imaging · 2023
Read paper →
Original research

Incidence and predictors of stroke and silent cerebral embolism following very high-power short-duration ablation

Reports stroke and silent brain-embolism rates after fast high-power ablation, identifying patient factors that raise or lower risk.

Gupta D, et al.Europace · 2023
Read paper →
Original research

Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter

Shows that freezing the pulmonary veins can treat atrial flutter as a first option, a less invasive alternative to conventional ablation.

Gupta D, et al.Heart · 2023
Read paper →
Review & editorial

Frequent premature atrial contractions as a signalling marker of atrial cardiomyopathy, incident atrial fibrillation, and stroke

Explains why frequent extra beats from the upper chambers, once thought harmless, are now linked to a higher chance of developing AF and stroke, and what that means for monitoring and treatment.

Gupta D, et al.Cardiovascular Research · 2023
Read paper →
Review & editorial

Outcomes of atrioventricular node ablation and pacing in patients with heart failure and atrial fibrillation: from cardiac resynchronization therapy to His bundle pacing

Reviews the pace and ablate approach for people with AF and heart failure, where a pacemaker takes over the rhythm, and compares the pacing options from resynchronisation to His bundle pacing.

Gupta D, et al.Journal of Cardiovascular Development and Disease · 2023
Read paper →
Review & editorial

Left atrial appendage occlusion: a choice or a last resort? How to approach the patient

Weighs whether appendage closure should be reserved for people who cannot take blood thinners or offered as a genuine alternative, and sets out how to approach the decision with each patient.

Gupta D, et al.Cardiac Electrophysiology Clinics · 2023
Read paper →
Guideline

How to use digital devices to detect and manage arrhythmias: an EHRA practical guide

European expert guidance on using smartwatches and phone apps to spot irregular heart rhythms and decide when further testing is needed.

Gupta D, et al.Europace · 2022
Read paper →
Original research

Outcomes of left atrial appendage occlusion vs. non-vitamin K antagonist oral anticoagulants

Real-world comparison of closing the appendage versus taking newer blood thinners, helping patients who cannot tolerate long-term anticoagulation.

Gupta D, et al.Clinical Research in Cardiology · 2022
Read paper →
Original research

Clinical outcomes with very high power very short duration ablation for atrial fibrillation

Tests a faster ablation technique that delivers high energy in brief bursts, with shorter procedure times and safety outcomes reported in detail.

Gupta D, et al.Journal of Cardiovascular Electrophysiology · 2022
Read paper →
Review & editorial

Improvement in hard outcomes following catheter ablation for atrial fibrillation: the debate is far from over

Examines whether ablation genuinely reduces stroke and heart failure, not just symptom relief, and where the evidence still has gaps.

Gupta D, et al.Europace · 2022
Read paper →
Original research

Impact of early ablation of atrial fibrillation on long-term outcomes

Follows patients over years to show that treating AF sooner, rather than waiting, is linked to better long-term heart health.

Gupta D, et al.Clinical Research in Cardiology · 2022
Read paper →
Review & editorial

Cardioneuroablation for vasovagal syncope and atrioventricular block: a step-by-step guide

Practical guidance on cardioneuroablation for fainting and nerve-driven heart block: who it suits, how the procedure is done, and what to expect afterwards.

Gupta D, et al.Journal of Cardiovascular Electrophysiology · 2022
Read paper →
Original research

Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Identifies which patients are at higher risk of blood clots forming on LAAO devices, helping doctors time anticoagulation more safely.

Gupta D, et al.Journal of the American College of Cardiology · 2021
Read paper →
Review & editorial

Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review

Synthesises the evidence for offering ablation early, before years of failed medications, in patients with intermittent AF.

Gupta D, et al.Heart · 2021
Read paper →
Original research

Quality of life and healthcare utilisation improvements after atrial fibrillation ablation

Documents how successful ablation improves day-to-day wellbeing and reduces hospital visits, outcomes patients care about most.

Gupta D, et al.Heart · 2021
Read paper →
Review & editorial

Smart wearables for cardiac monitoring: real-world use beyond atrial fibrillation

Reviews how wearables, patches and phone apps are used to monitor heart rhythm beyond AF, and what a reading from one can and cannot tell a doctor.

Gupta D, et al.Sensors · 2021
Read paper →
Review & editorial

The "heart brain" and neuromodulation for vasovagal syncope

Explains the network of nerves on the surface of the heart that can trigger a faint, and how catheter treatment of those nerves has moved from experiment to everyday practice in major hospitals.

Gupta D, et al.Autonomic Neuroscience · 2021
Read paper →
Original research

Cardioneuroablation for treatment of atrioventricular block

Reports patients whose heart block was driven by an overactive nerve supply and treated with cardioneuroablation rather than a pacemaker, with encouraging results in carefully selected people.

Gupta D, et al.Circulation: Arrhythmia and Electrophysiology · 2021
Read paper →
Original research

Long-term outcomes of left atrial appendage occlusion in high-risk atrial fibrillation patients: 4-year follow up data

Follows 71 high-risk patients for around four years after an Amulet implant. The stroke rate stayed low, though these frail patients remained at risk from other illnesses and from bleeding.

Gupta D, et al.Journal of Thrombosis and Thrombolysis · 2021
Read paper →
Clinical trial

Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation

Head-to-head comparison of keyhole surgical ablation versus catheter ablation for the hardest-to-treat persistent AF patients.

Gupta D, et al.European Heart Journal · 2020
Read paper →
Original research

Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation

Shows that measuring lesion quality during ablation leads to more durable vein isolation and fewer repeat procedures for paroxysmal AF.

Gupta D, et al.Circulation: Arrhythmia and Electrophysiology · 2018
Read paper →
Original research

Outcome of left atrial appendage occlusion in high-risk patients

Liverpool’s first 83 LAAO patients, nearly all with previous major bleeding. The device was implanted successfully in 99%, with the complications and one-year stroke and bleeding rates reported openly.

Gupta D, et al.Heart · 2018
Read paper →
Original research

Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection

Introduces the Ablation Index, a measure of lesion quality that predicts whether veins stay isolated, reducing the need for repeat procedures.

Gupta D, et al.Europace · 2016
Read paper →
Original research

Efficacy of Catheter Ablation for Persistent Atrial Fibrillation

Landmark single-centre series showing that even persistent AF can be treated successfully with ablation when done by an experienced operator.

Gupta D, et al.Circulation: Arrhythmia and Electrophysiology · 2014
Read paper →
Clinical trial

A randomized-controlled trial comparing conventional with minimal catheter approaches for the mapping and ablation of regular supraventricular tachycardias

A randomised trial of 200 patients showing that SVT and atrial flutter can be mapped and ablated with fewer catheters, just as safely and effectively, and at lower cost.

Gupta D, et al.Europace · 2009
Read paper →
Original research

Current case mix and results of catheter ablation of regular supraventricular tachycardia: are we giving unrealistic expectations to patients?

Looks at nearly 400 SVT ablations in one large centre and asks whether the success rates quoted to patients are realistic. Repeat procedures did less well than first ones, which is a reason to get it right first time.

Gupta D, et al.Europace · 2007
Read paper →
Original research

Cryoablation compared with radiofrequency ablation for atrioventricular nodal re-entrant tachycardia: analysis of factors contributing to acute and follow-up outcome

Compares two ways of ablating AVNRT, the most common type of SVT. Freezing was gentler on the heart’s wiring but the rhythm came back more often, so heat remained the more reliable choice.

Gupta D, et al.Europace · 2006
Read paper →

Selected highlights from more than 350 peer-reviewed publications, cited over 13,000 times. View full list on ORCID →

Common questions

Your questions, plainly answered.

Is PFA newer and therefore better?

PFA (pulsed field ablation) is newer, but newer does not automatically mean better. In the largest studies directly comparing the two, published in 2025, PFA and RFA (radiofrequency ablation) produced broadly comparable results.¹ What consistently makes the biggest difference to safety and success in published research is the experience of the doctor performing the procedure.²

Is catheter ablation safe?

Catheter ablation is a routine, well-established procedure carried out hundreds of thousands of times a year worldwide. Like any procedure it carries some risk, and your doctor will explain those risks for your situation. Published research shows complication rates are lower at centres and with doctors who perform a high volume of these procedures.² Professor Gupta’s published complication rate is below 1%.³

Which technology will I get - RFA or PFA?

Professor Gupta is trained and experienced in both. Neither is right for every patient. He will assess your heart, your history and your preferences, explain the options in plain language, and recommend the one that suits you - not the one that happens to be available.

How long does recovery take?

Most patients go home the same day or the next morning, and are back to normal light activity within a few days. Your care team will give you clear, written instructions for the first weeks, and follow-up is arranged with a trusted local cardiologist under Professor Gupta’s supervision.

Do I need to travel to the UK?

No. Consultations and procedures take place in Mumbai during Professor Gupta’s scheduled visits. Between visits, your follow-up happens locally, coordinated with cardiologists he works with - so you are never without a doctor close to home.

What happens at the first consultation?

An unhurried conversation. Professor Gupta will review your history, any recordings or scans you have, and explain what is happening in your heart in plain language - in English, Hindi or Punjabi. You will leave with a clear plan, whether or not that plan includes a procedure.

Convinced by the evidence? Ask the questions that matter to you.

A short enquiry costs nothing, and every one is answered.

Book a consultation

Next Mumbai visit: March 2026 · Booking open

References

  1. Head-to-head randomised comparison of PFA vs RFA for paroxysmal AF, 2025.
  2. Volume-outcome relationship in catheter ablation of atrial fibrillation: systematic review.
  3. Published single-operator complication-rate series, Liverpool Heart and Chest Hospital.
  4. National registry data on AF ablation complication rates by centre volume.