Ablation of persistent and long-standing persistent AF: beyond pulmonary vein isolations with a novel balloon-in-basket pulsed-field ablation catheter

Introduction A novel balloon-in-basket catheter (BiBC) has been validated for pulmonary vein isolation (PVI) but scarce data exist on its use beyond PVI in patients with persistent (PAF) and long-standing persistent (LSPAF) atrial fibrillation (AF) [1-4]. Purpose We hypothesised that BiBC, with its mapping, pacing and pulsed field ablation (PFA) capability, might be use for individualised ablation in PAF nad LSPAF patients. Methods In 15 consecutive PAF and LSPAF patients PFA ablation with BiBC was performed. All patients had failed treatment with class I and/or III antiarrhythmic drugs and were undergoing their first AF ablation. PFA involved PVI, low voltage area (LVA), superior vena cava (SVC), left atrium appendage isolation and cavo-tricuspid isthmus (CTI) ablation. Results Patients` and procedural characteristics are presented in Table 1 and 2, respectively. One groin hematoma was our main complication. No other peri-procedural serious events (death, TIA/stroke, tamponade or pericardial effusion, phrenic nerve injury, coronary spasm or injury, atrio-esophagal fistula, haemolysis or kidney insufficiency) was observed. All patients, in sinus rhythm, were discharged without complications and any anti-arrhythmic drugs . Median (min,max) hospital stay was 3 (3,7) days. No AF/AT/AFL recurrence was observed in 14/15 (93%) patients in acute follow-up of median 22 (14,35) days since the procedure. One patient from our first ever session with BiBC (LVA not ablated on posterior wall) had AF relapse 3 weeks after the index ablation - sinus rhythm returned after oral Amiodarone. Conclusion(s) Extended ablation using BiBC in patients with PAF and LSPAF is safe and might improved outcomes in this cohorts. Further studies are recommended to confirm these findings.