Ablation of extra pulmonary vein areas with two different pulsed field ablation catheters

Background Previous report on acute isolation of extrapulmonary area with pulse field ablation (PFA) showed good acute results but long-term outcomes are still variable. Aim The aim of our study was to analyse the difference between a single shot pentaspline PFA and a focal lattice-tip dual energy catheter. Methods We analysed prospectively collected data of consecutive non-paroxysmal AF patients undergoing redo ablation procedure underwent isolation of left atrial appendage (LAA) and coronary sinus (CS) and ablation of mitral isthmus (MI) between November 2024 and September 2025. CS isolation was performed endocardially with the catheter on the floor of the left atrium and epicardially inside the CS. LAA isolation was performed with application at the ostium and inside the LAA. MI was ablated from the left inferior pulmonary vein to the mitral valve in a linear fashion. Results 297 patients (161, 54.2% male) undergoing repeat-ablation were included in our analysis. 78 patients (26.3%) underwent ablation with the lattice-tip catheter using PFA only, 104 patients (35.0%) with the lattice-tip catheter using a combination of PFA and radiofrequency at the LAA ostium, and 115 patients (38.7%) with the pentaspline catheter. Acute isolation and block were achieved in all patients. At remapping at 98±24days during LAA occlusion, persistent isolation of LAA was found in 5(6.4%), 69(63.5%) and 1(0.9%) patients with lattice-tip PFA only group, lattice-tip using energy combination and pentaspline respectively; MI block was observed in 95 (52.2%) and 2(1.7%) with lattice-tip and pentaspline; CS isolation in 83(45%) and 2(1.7%) with lattice-tip and pentaspline. Conclusion Dual-energy catheter showed significantly a higher incidence of persistent isolation in extra-pulmonary area when compared to single-shot PFA catheter.