What does this research mean for the field?

Adjunctive posterior wall isolation with pulsed field ablation led to 9% inducibility of left reentrant atrial tachycardias compared to 3% in the non-PWI group, with no significant difference overall. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the effect of posterior wall isolation using pulsed field ablation on inducible atrial tachycardias after pulmonary vein isolation in patients with atrial fibrillation.

February 6, 2026

Impact of adjunctive posterior wall isolation with pulsed field ablation on inducibility of atrial flutter following pulmonary vein isolation

Key Result

Adjunctive PWI with PFA led to 9% inducibility of left reentrant atrial tachycardias compared to 3% in the non-PWI group (p=0.0888), with no significant difference overall.

Key Points

To evaluate the effect of posterior wall isolation using pulsed field ablation on inducible atrial tachycardias after pulmonary vein isolation in patients with atrial fibrillation.
Included patients undergoing first-time catheter ablation of atrial fibrillation with pulsed field ablation.
Collected demographic, clinical, and procedural data from patients.
Conducted programmed atrial stimulation post-ablation with and without isoproterenol or dobutamine.
228 patients were analyzed; 45% underwent adjunctive posterior wall isolation.
17% had inducible reentrant atrial tachycardias after initial ablation.
No significant difference in inducibility rates between groups (20% with PWI vs. 14% without PWI).

Structured PICO

Does adjunctive posterior wall isolation with pulsed field ablation reduce the inducibility of reentrant atrial tachycardias following pulmonary vein isolation in patients undergoing first-time catheter ablation for atrial fibrillation?

Population

228 patients undergoing first-time catheter ablation of atrial fibrillation using pulsed field ablation, mean age 67±11 years, 33% female.

Intervention

Pulmonary vein isolation (PVI) with adjunctive posterior wall isolation (PWI) using pulsed field ablation (PFA) via a pentaspline catheter.

Comparator

Pulmonary vein isolation (PVI) without adjunctive posterior wall isolation (PWI) using pulsed field ablation (PFA).

Outcome

Rate of inducibility of reentrant atrial tachycardias/flutters (ATs) post-ablation during programmed atrial stimulation.surrogate

Adjunctive posterior wall isolation with pulsed field ablation during first-time AF ablation does not significantly impact the immediate post-ablation inducibility of reentrant atrial tachycardias compared to PVI alone.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background The safety and efficacy of pulsed field ablation (PFA) for pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is well-established. Increasingly, posterior wall isolation (PWI) with PFA has been used as an adjunctive ablation strategy. The impact of PWI with PFA on post-ablation inducibility of reentrant atrial tachycardias/flutters (ATs) is unclear. Purpose To characterize and compare inducible reentrant ATs among patients undergoing PVI with and without adjunctive PWI for de novo catheter ablation of AF. Methods Patients undergoing PFA using a pentaspline catheter (Farapulse, Boston Scientific) for first-time catheter ablation of AF were included in the study. Demographic, clinical and imaging data as well as procedural characteristics were collected. All patients underwent post-ablation programmed atrial stimulation with and without isoproterenol/dobutamine. Results A total of 228 patients (mean age 67±11 years; 76 (33%) female) were included in the study. One hundred and three (45%) patients underwent adjunctive PWI at operator discretion. Overall, 38 (17%) patients had inducible reentrant ATs post-initial ablation, which included 24 (11%) with cavotricuspid isthmus-dependent, 1 (0.44%) with peri-tricuspid, 8 (3.5%) with peri-mitral, 1 (0.44%) with anterior LA, 2 (0.88%) with roof-dependent LA, 2 (0.88%) with septal, and 2 (0.88%) with SVC-dependent ATs. There was no significant difference in rate of inducibility of reentrant ATs between those who did and did not undergo PWI (20% vs. 14%; p=0.2117). After excluding inducible right ATs, 9 (9%) patients in the PWI group (example shown in Figure) compared to 4 (3%) patients in the non-PWI group had inducible left ATs (p=0.0888). Conclusion Adjunctive PWI with PFA was associated with low rates of inducible left reentrant AT after initial ablation. The impact of adjunctive PWI with PFA on long-term freedom from AT/AF remains to be defined.septal AT after PWI (1/2) septal AT after PWI (2/2)

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