TWOSOME Trial: Single-Shot Versus Single-Tip Pulsed Field Ablation for Pulmonary Vein Isolation

Inclusion Criteria: * Recurrent, symptomatic paroxysmal atrial fibrillation * Age \> 18 years * Patient consen Exclusion Criteria: * Refusal of the patient * Inability to provide informed consent * Life expectancy \< 2 years * Pregnancy and breastfeeding (due to radiation exposure) * History of left atrial ablation * Known macro-reentry or focal atrial tachycardia * Significant mitral valve stenosis * History of heart valve replacement or reconstruction * NYHA class III and IV * Left ventricular ejection fraction \< 35% * Left atrial enlargement \> 55 mm on echocardiography * Intracardiac thrombus prior to the procedure * Severe pulmonary disease with abnormal blood gases or requiring oxygen therapy * Renal insufficiency (GFR \< 30 mL/min) due to contrast medium use * Stroke or TIA within the last 6 months * Symptomatic carotid stenosis * Active malignancy within the previous 24 months * Untreated or uncontrolled thyroid disease * Active bleeding or chronic bleeding tendency not amenable to curative treatment * Body mass index \> 35 kg/m² * Contraindication to CT examination (e.g., contrast medium allergy or severe claustrophobia)