Beyond the Learning Curve: How Operator Experience Affects Pulsed-Field Ablation Outcomes.

Background: The learning curve for pulmonary vein isolation (PVI) using "single-shot" pulsed-field ablation (PFA) is thought to be short. 3D electro-anatomical mapping (3D-EAM) might provide adjunctive information to shorten the learning curve and improve lesion durability.

Objective: To analyze procedural performance markers over time for PVI using PFA and 3D-EAM.

Hemolysis Induced by Pulsed-Field Ablation of Atrial Arrhythmias: A Comparative Analysis of Current Systems.

Introduction: Pulsed-field ablation (PFA) is an emerging technology associated with dose-dependent hemolysis as a recently recognized side effect. This study aimed to compare hemolysis levels and assess dose-dependency across three PFA systems: a pentaspline catheter (PSC), a lattice-tip focal catheter (LTFC), and a variable loop circular catheter (VLCC).

Methods: Patients treated for atrial arrhythmias with the LTFC (n = 29) or the VLCC (n = 30) were included from a prospective registry.

Are there pulmonary vein geometrical features associated with reconnection after pulsed field ablation of atrial fibrillation?

Background: Pulmonary vein (PV) isolation (PVI) using pulsed field ablation (PFA) is an emerging technique for the treatment of atrial fibrillation (AF). However, the recurrence rate of AF remains significant, and the durability of PVI is insufficient.

Objective: This study aimed to assess the impact of anatomical and geometrical features of the PV ostia on the PVI durability.

Voltage threshold adjustments for a novel pulsed-field ablation catheter with integrated mapping capabilities: lessons from a case series.

Background: Accurate electroanatomical mapping relies on voltage thresholds to differentiate electrically inactive areas, fibrotic scar, and healthy myocardium. These thresholds have been well established for high-density mapping catheters with small, closely spaced electrodes. However, the optimal voltage thresholds for a novel pulsed-field ablation catheter with integrated mapping capabilities remain unclear.

Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry.

Background: Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.

Objective: This study aims to assess the efficacy and safety of PFA in patients with persistent AF.

Methods: Data from early commercial use across seven European centers were collected in a registry.

Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation.

Background: Pulmonary-vein isolation is an effective treatment for paroxysmal atrial fibrillation. Pulsed field ablation (PFA) is a nonthermal ablation method with few adverse effects beyond the myocardium. Data are lacking on outcomes after PFA as compared with cryoballoon ablation as assessed with continuous rhythm monitoring.

Pulsed-Field vs Thermal Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.

Background: Pulsed-field ablation (PFA) may be beneficial for the treatment of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM).

Objectives: The goal of this study was to compare the safety and efficacy of PFA and thermal ablation in patients with HCM and AF.

Methods: From 2016 to 2024, patients with HCM undergoing a first AF ablation using PFA or thermal ablation (cryoballoon or radiofrequency) were retrospectively included from 3 French and Swiss centers.

Dose-dependent ventricular lesion formation using a novel large-area pulsed field ablation catheter: A preclinical feasibility study.

Background: Pulsed field ablation (PFA) has shown promising data in terms of safety and procedural efficiency for pulmonary vein isolation. Large-area focal PFA catheter designs might be suitable to deliver deep and durable lesions in ventricular myocardium.

Objective: We aimed to investigate the dose-response of a novel large-area focal 3-dimensional (3D)-enabled map-and-ablate PFA catheter for ventricular ablation in a chronic preclinical swine model.

Comparison of a Novel Temperature-Controlled Diamond-Tip Catheter and a Power-Controlled Gold-Tip Catheter for the Irrigated Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter.

: Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) is a recommended treatment option for typical atrial flutter (AFL). While power-controlled ablation has been the current standard, a novel temperature-controlled ablation system has been introduced. We aimed to compare the procedural efficacy and one-year outcome of a temperature-controlled diamond-tip catheter with an established power-controlled gold-tip catheter.

Repeat procedures after pulsed field ablation for atrial fibrillation: MANIFEST-REDO study.

Aims: Initial clinical studies of pulsed field ablation (PFA) to treat atrial fibrillation (AF) indicated a >90% durability rate of pulmonary vein isolation (PVI). However, these studies were largely conducted in single centres and involved a limited number of operators. We aimed to describe the electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF.

Impact of shortening the blanking period to 8 weeks after PVI: Insights from COMPARE-CRYO using continuous rhythm monitoring.

Background: Early recurrences of atrial tachyarrhythmias (ERATs) after pulmonary vein isolation (PVI) are common. While many correlate to late recurrences (LRs), some do not. The impact of ERATs timing is difficult to assess with noninvasive Holter monitoring because of undersampling.

Pulsed Field Ablation as First-Line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry.

Background: Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy.

Effect of electrode size and distance to tissue on unipolar and bipolar voltage electrograms and their implications for a near-field cutoff.

Characteristics of electrograms depend on the electrode design and distance to the electric source. Our aim was to assess the impact of electrode design and distance from the myocardial electric source on the unipolar and bipolar electrograms to deduce a far-field cut-off. We retrospectively analyzed left atrial electroanatomical maps of 25 patients acquired using an ablation catheter with a 4.

Safety and efficacy of pulsed-field ablation for atrial fibrillation in the elderly: A EU-PORIA sub-analysis.

Background: The role of catheter ablation in elderly patients with atrial fibrillation (AF) is unclear. Pulsed field ablation (PFA) demonstrates a favorable clinical profile, however, data on elderly patients are lacking.

Aims: We aimed to assess the safety and efficacy of PFA in the elderly, using data from the EU-PORIA registry.

Feasibility study on atrial fibrillation ablation with pulsed field ablation and concomitant occlusion of the left atrial appendage.

Aims: Atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) are increasingly performed as individual procedures. Pulsed field ablation (PFA) has significantly reduced procedure duration and may be advantageous for the combined approach.

Methods And Results: We have launched a programme for simultaneous AF ablation using PFA and LAAO for patients qualifying for both treatments and excluding those with a complex anatomy.

Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis.

Background: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).

Objective: To assess the outcomes of pulsed-field ablation (PFA) in HF.

Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients With Heart Failure.

Background: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).

Objective: This study sought to assess the outcomes of pulsed field ablation (PFA) in HF.

Pulsed-field ablation for repeat procedures after failed prior thermal ablation for atrial fibrillation.

Background: Pulsed-field ablation (PFA) is a novel nonthermal ablation technology. Its potential value for repeat procedures after unsuccessful thermal ablation for atrial fibrillation has not been assessed.

Objective: The purpose of this study was to summarize our initial experience with patients undergoing repeat procedures using PFA.