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Arrhythmias & electrophysiologyResearch article

Monopolar biphasic focal pulsed field ablation directly at the atrioventricular junction and from within the noncoronary cusp: The PFA-CONDUCT study

Heart RhythmPublished

  • Preclinical (porcine) and clinical study
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Authors' conclusion

F-PFA directly at the AV junction results in nonreversible AV block. F-PFA from within the NCC may represent a promising strategy for treating para-Hisian arrhythmias while preserving AV conduction.

Study context

Population
Pigs and patients undergoing focal pulsed field ablation at the atrioventricular (AV) junction or from within the aortic noncoronary cuspPigs, direct focal pulsed field ablation (F-PFA) at AV junction 3 · Pigs, F-PFA from within the noncoronary cusp (NCC) 5 · Patients planned for pace-and-ablate strategy 5 · Patient with recurrent para-Hisian atrial tachycardia 1
Participants
3 / 5 / 5 / 1
Comparison
Direct or indirect F-PFA application at the AV junction
  • Direct F-PFA at the AV junction (pigs)n = 3
  • F-PFA from within the NCC (pigs)n = 5
  • Pace-and-ablate patientsn = 5
  • Para-Hisian atrial tachycardia patientn = 1

Main finding

As reported in the abstract

AV conduction with direct F-PFA at the AV junction (pigs)
  • Junctional beats and complete AV block after 2-3 F-PFA applications

Further findings

Tissue histology (pigs, direct F-PFA)

Lesion depth
approximately 8 mm
Minor hemorrhage and leukocyte infiltration

AV conduction with F-PFA from within the NCC (pigs)

Pigs with transient AV block, recovered within 10 minutes
1
Transient increase in the AV node's Wenckebach cycle length

AV conduction in pace-and-ablate patients

Sustained AV block

Para-Hisian atrial tachycardia with F-PFA from within the NCC

Termination and noninducibility of a recurrent incessant para-Hisian atrial tachycardia without AV block

Complications

No immediate or long-term complications

Original publication

Monopolar biphasic focal pulsed field ablation directly at the atrioventricular junction and from within the noncoronary cusp: The PFA-CONDUCT study. Heart Rhythm. Published 9 January 2026. doi:10.1016/j.hrthm.2026.01.012
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Summarised from the published abstract; every number is checked against it