Key result
Balloon-in-basket PFA is linked to ~97% greater durable PV isolation at repeat procedures versus cryoballoon ablation.
Why the study?
Electrophysiological recurrence patterns following balloon-in-basket pulsed field ablation for atrial fibrillation remain incompletely characterized.
Does initial balloon-in-basket pulsed field ablation improve pulmonary vein durability compared to cryoballoon ablation in patients undergoing repeat ablation for recurrent atrial tachyarrhythmias?
Cohort (n=36)
Does initial balloon-in-basket pulsed field ablation improve pulmonary vein durability compared to cryoballoon ablation in patients undergoing repeat ablation for recurrent atrial tachyarrhythmias?
Absolute Event Rate: 75% vs 38%
p-value: p=0.034
Balloon-in-basket pulsed field ablation results in significantly higher pulmonary vein durability compared to cryoballoon ablation, suggesting that arrhythmia recurrences after PFA are more often driven by non-pulmonary vein mechanisms.
May indicate distinct PV reconnection mechanisms after BiB-PFA versus CBA; leaves open optimal first-line ablation choice pending prospective data.
Background Several reports have focused on repeat procedures after pulsed field ablation (PFA)–guided pulmonary vein isolation (PVI) for atrial fibrillation (AF). However, the electrophysiological recurrence patterns following balloon-in-basket (BiB)-PFA remain incompletely characterized. Objective To compare pulmonary vein (PV) durability, reconnection patterns, and mechanisms of arrhythmia recurrence after BiB-PFA versus cryoballoon ablation (CBA). Methods Consecutive patients undergoing repeat ablation procedures for recurrent atrial tachyarrhythmias after initial BiB-PFA or CBA were retrospectively analyzed. Propensity score matching (1:2) was performed using age, AF type, and left atrial volume index. During repeat procedures, all PVs were systematically assessed using high-density electroanatomical mapping. PV durability, reconnection patterns, and substrate characteristics were compared. Results After propensity score matching, 12 patients undergoing repeat procedures after BiB-PFA and 24 after CBA were included. Durable isolation of all PVs was significantly more frequent after BiB-PFA than after CBA (75% vs 38%, P=0.034). At the PV level, durable isolation was observed in 45/48 PVs (94%) after BiB-PFA versus 62/96 PVs (65%) after CBA (P<0.001). Reconnection after BiB-PFA was predominantly localized to the anterior or posterior aspects of the left-sided PVs, whereas CBA demonstrated broader reconnection patterns. Extensive low-voltage areas were more frequently observed during repeat procedures after BiB-PFA compared with CBA (P=0.035). Conclusions Repeat procedures after BiB-PFA demonstrated a distinct electrophysiological recurrence phenotype characterized by highly durable PVI, focal reconnection patterns, and substrate-related arrhythmia mechanisms compared with CBA. These findings suggest that recurrence after BiB-PFA increasingly reflects non-PV arrhythmogenic mechanisms rather than extensive lesion failure.
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Ukita et al. (2026) conducted a cohort in Recurrent atrial tachyarrhythmias after initial ablation for atrial fibrillation (n=36). Balloon-in-basket pulsed field ablation (BiB-PFA) vs. Cryoballoon ablation (CBA) was evaluated on Durable isolation of all pulmonary veins (p=0.034). Repeat procedures after balloon-in-basket pulsed field ablation demonstrated significantly higher durable isolation of all pulmonary veins compared with cryoballoon ablation (75% vs 38%, P=0.034).
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