Comparative 1-year outcomes of pentaspline versus circular array pulsed field ablation for pulmonary vein isolation with adjunctive atrial lines.

BACKGROUND

Pulsed field ablation (PFA) has emerged as an effective and safe single-shot technology for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, comparative long-term outcome data between different PFA catheter designs, particularly for additional atrial ablation beyond PVI, remain scarce.

OBJECTIVE

This study aimed to compare 1-year clinical outcomes and procedural performance of pentaspline versus circular PFA catheters for PVI with additional left atrial roof line ablation (LARA).

METHODS

Consecutive patients undergoing fluoroscopy-guided PVI using either a pentaspline or circular PFA catheter between November 2023 and November 2024 were included. LARA was performed in patients with persistent AF and left atrial enlargement (LA area >20 cm2). The primary end point was freedom from atrial arrhythmia after a 3-month blanking period.

RESULTS

A total of 200 patients were included (65% male, 44% persistent AF, median age 66 [interquartile range {IQR} 59-74] years), with 100 patients per group and no baseline differences. LARA was performed in 30% (30/100) of pentaspline and 32% (32/100) of circular PFA procedures, respectively. Acute PVI and bidirectional block of all additional lines were achieved in 100% of cases. Median procedure time (63 [IQR 54-77] vs 67 [IQR 59-80] min; P = .06) and fluoroscopy time (11.9 [9.8-15.2] vs 13.2 [10.2-15.9] min; P = .203) were comparable. Overall complication rates were low and similar (5% vs 3%). During a median follow-up of 386 (IQR 349-486) days, 1-year arrhythmia-free survival was similar between pentaspline and circular PFA catheters (81.7% vs 81.8%; log-rank P = .90), with comparable outcomes in paroxysmal and persistent AF.

CONCLUSION

Pentaspline and circular PFA catheters demonstrate comparable safety, procedural performance, and 1-year clinical efficacy for PVI and LARA. These findings support the feasibility of comprehensive PFA-based atrial ablation strategies in patients with persistent atrial fibrillation and enlarged left atria.