Versatility of the novel balloon-in-basket pulsed field ablation catheter: Pulmonary vein isolation and beyond.

BACKGROUND

Pulsed field ablation is an established energy source for catheter ablation (CA) of arrhythmias. Recently, a novel balloon-in-basket pulsed field ablation (BiBPFA) catheter has been introduced; however, its use beyond pulmonary vein isolation (PVI) has not yet been studied.

OBJECTIVE

This study aimed to demonstrate the feasibility of versatile CA of atrial fibrillation, atrial flutter (AFL), and atrial tachycardia (AT) using the novel BiBPFA catheter.

METHODS

Consecutive patients undergoing CA, including index and repeat procedures, using the novel BiBPFA catheter in a single center from June 2025 to March 2026 were analyzed. CA involved PVI/re-PVI, cavotricuspid isthmus ablation, and left atrial substrate modification, including anterior lines, roof lines, posterior wall isolation, and focal ablation. Endpoints included acute procedural success and procedural safety.

RESULTS

A total of 42 patients were included (age 68.4 ± 9.7 years; CHA2DS2-VA score 2.4 ± 1.4; 77.8% males; 64.3% persistent atrial fibrillation; 16.7% with AFL; 9.5% with AT) in this study. CA included the isolation/reisolation of 231 pulmonary veins (14.4 ± 3.3 applications), 7 cavotricuspid isthmus ablations (10.6 ± 8.1 applications), and left atrial substrate modification, including 1 anterior line (12 applications), 6 roof lines (6 ± 1.6 applications), 9 posterior wall isolations (15.3 ± 6), and 1 focal ablation (8 applications). Acute procedural success was achieved in all 42 patients (100%). No procedural complications occurred.

CONCLUSION

Initial experience with the novel BiBPFA catheter suggests broad procedural versatility beyond PVI, enabling effective mapping and ablation of ATs and right AFL and atrial substrate modification using a single-device approach.