Arrhythmias & electrophysiology
Pulsed field ablation with a pentaspline catheter and concomitant left atrial appendage closure for long-standing persistent atrial fibrillation: Comparison with a radiofrequency cohort
Authors' conclusion
Extensive PFA, including LAA electrical isolation, combined with LAAO was feasible and safe, resulting in shorter procedures, fewer overall PDLs compared with RF but similar rate of PDL >3 mm.
Study context
- Population
- Patients with drug-refractory, long-standing persistent atrial fibrillation (AF) undergoing combined ablation (pulmonary veins, posterior wall, and LAA electrical isolation) plus left atrial appendage occlusion (LAAO)Pulsed field ablation (PFA) 45 · RF 45
- Participants
- 90 consecutive patients
- Exposure
- extensive PFA combined with LAAO, compared with radiofrequency ablation plus LAAO
- PFAn = 45
- RFn = 45
Methodological detailsconsecutive patients, 1:1 matching based on age, CHA2DS2-VASc score, HAS-BLED score, and LAAO device, follow-up censored at 12 months
- Consecutive patients
- 1:1 matching based on age, CHA2DS2-VASc score, HAS-BLED score, and LAAO device
- Follow-up censored at 12 months
Main finding
As reported in the abstract
Procedural time
P = 0.042
Observational data: associations, not effects.
Further findings
Overall peri-device leak (PDL) · lower with PFA
P = 0.048
Clinically relevant leaks >3 mm · infrequent and comparable
P = 0.494
Arrhythmic recurrences · 12 months · numerically lower with PFA; log-rank P = 0.093
P = 0.069
Acute LAAO success
- Acute LAAO success in both groups
- 100%
Baseline characteristics
- Baseline characteristics were balanced after matching
Predictors of recurrence (Cox regression)
- AF duration >18 months predicted recurrence, hazard ratio
- 3.27, 95% confidence interval 1.15-9.32; P = 0.027
- Only AF duration >18 months predicted recurrence
Safety
| Outcome | PFA | RF | |
|---|---|---|---|
| Complications (pericardial effusion) · similar complication rates | 1 events | 1 events | |
| Stroke and major bleeding | |||
| Stroke | No strokes | Not reported in the abstract | RF: not reported in the abstract |
| Major bleeding | No major bleeding | Not reported in the abstract | RF: not reported in the abstract |
| Non-cardioembolic stroke | Not reported in the abstract | 1 | PFA: not reported in the abstract |
| Major bleeding events | Not reported in the abstract | 2 | PFA: not reported in the abstract |
Original publication
Pulsed field ablation with a pentaspline catheter and concomitant left atrial appendage closure for long-standing persistent atrial fibrillation: Comparison with a radiofrequency cohort. Heart Rhythm. Published 17 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it