Key result
Hybrid RF and pulsed-field ablation achieves 100% acute mitral isthmus block in observational cohort.
Why the study?
The mitral isthmus is an anatomically challenging region where durable transmural lesions are difficult to achieve with radiofrequency ablation alone, and standalone pentaspline pulsed-field ablation shows limited long-term durability.
Does a hybrid radiofrequency and pulsed-field ablation strategy improve acute bidirectional block and long-term sinus rhythm in patients undergoing mitral isthmus ablation for persistent AF or AT?
Observational (n=77)
No
Does a hybrid radiofrequency and pulsed-field ablation strategy improve acute bidirectional block and long-term sinus rhythm in patients undergoing mitral isthmus ablation for persistent AF or AT?
A hybrid ablation strategy combining radiofrequency and pulsed-field energy achieves high acute success and durable block for the anatomically challenging mitral isthmus.
Supports hybrid RF-PFA mitral isthmus ablation in persistent AF/AT; hypothesis-generating and warrants randomized trials to confirm durability.
The mitral isthmus (MI) represents an anatomically challenging region characterized by complex architecture and a significant epicardial component, often precluding durable transmural lesions. While achieving transmurality was formidable with radiofrequency (RF) energy, Pulsed Field Ablation (PFA) offers a promising alternative for this technically demanding substrate. Linear MI ablation is indicated for treating macro-reentrant atrial tachycardias (ATs) and serves as an adjunctive strategy in persistent atrial fibrillation (AF).
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Ioannidis et al. (2026) conducted an observational in Persistent atrial fibrillation or atrial tachycardia (n=77). Hybrid pentaspline pulsed-field and radiofrequency ablation was evaluated on Acute bidirectional block of the mitral isthmus. A hybrid ablation strategy combining radiofrequency and pulsed-field energy achieved a 100% acute success rate for mitral isthmus block, with 71.4% of patients in sinus rhythm at 19.5 months.
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