Pentaspline catheter or cryoballoon for pulmonary vein plus posterior wall isolation in persistent atrial fibrillation: 1-Year outcomes

Background: Left atrial posterior wall isolation (LAPWI) plus pulmonary vein isolation (PVI) can be performed with radiofrequency ablation, cryoballoon ablation (CB-A), or, recently, pulsed field ablation (PFA).

Objective: The aims of this study were to evaluate efficacy and safety of the pentaspline PFA catheter for PVI + LAPWI in patients with persistent AF undergoing an index ablation procedure and to compare 1-year outcomes of PVI + LAPWI with PFA vs CB-A.

Methods: All consecutive patients undergoing an index ablation for persistent atrial fibrillation (AF) at Universitair Ziekenhuis Brussel, Belgium, between 2021 and 2023 were retrospectively screened. Inclusion criteria were persistent AF diagnosis following current guidelines, first AF ablation procedure with PVI + LAPWI using the CB-A or the pentaspline PFA catheter, and 1-year follow-up completed.

Results: A total of 160 patients were included (80 with CB-A and 80 with the pentaspline PFA catheter). PVI + LAPWI was performed with success in 160 (100%) patients, and isolation was confirmed at postprocedure high-density mapping in all. Compared with CB-A, PFA was associated with shorter skin-to-skin procedure time, shorter left atrium dwell time, and shorter fluoroscopy time. At survival analysis, freedom from recurrent atrial tachyarrhythmias at 1-year follow-up was similar between the CB-A and PFA groups (76.2% vs 78.8%; log-rank P = .63).

Conclusion: In patients with persistent AF undergoing an index catheter ablation, the pentaspline PFA catheter is safe and effective for PVI + LAPWI. Outcomes after pentaspline PFA catheter ablation at 1 year are favorable and similar to those with the CB-A catheter.