Key result
PFA with PVI plus posterior wall isolation shows no benefit over PVI alone for ATA recurrence.
Why the study?
The value of lesion sets beyond PVI for AF ablation is unclear, and there are limited data evaluating PVI with posterior wall isolation using pulsed field ablation.
Does PVI plus PWI compared to PVI alone reduce atrial tachyarrhythmia recurrence in patients with paroxysmal atrial fibrillation undergoing first-time pulsed field ablation?
Cohort (n=249)
Does PVI plus PWI compared to PVI alone reduce atrial tachyarrhythmia recurrence in patients with paroxysmal atrial fibrillation undergoing first-time pulsed field ablation?
Adding posterior wall isolation to pulmonary vein isolation using pulsed field ablation for first-time paroxysmal AF ablation does not improve sinus rhythm maintenance or significantly alter procedure times and complication rates.
Answers are grounded in this paper and cite their sources.
No recurrence benefit from added posterior wall isolation; leaves open optimal lesion sets for pulsed field ablation.
Background The value of additional lesion sets beyond pulmonary vein isolation (PVI) for atrial fibrillation (AF) ablation is unclear. However, existing studies evaluated the utility of substrate modification with conventional energy sources. There is limited data evaluating PVI with posterior wall isolation (PWI) using pulsed field ablation (PFA). Methods We studied consecutive cases of patients with paroxysmal AF undergoing first‐time ablation with PFA between May 6, 2024 and March 10, 2025. Procedural data collected included the number of PFA applications administered, total procedure time, and major periprocedural complications. Clinical data collected included atrial tachyarrhythmia (ATA) recurrence, stroke, and major bleeding at 1‐year follow‐up. Outcomes were compared in patients undergoing PVI alone versus PVI plus PWI. Results A total of 249 patients were included in this study (104 PVI alone, 145 PVI plus PWI). There was no difference in ATA recurrence by Kaplan–Meier survival analysis comparing PVI alone versus PVI plus PWI (log rank test p = 0.89). When comparing PVI alone versus PVI plus PWI, there was no difference in ATA recurrence at 1 year (16% vs. 16%; p = 0.92), AF burden on continuous monitoring (2% vs. 2%; p = 0.81), total procedure time (114 vs. 107 min; p = 0.14), or major periprocedural complications (0 vs. 3; p = 0.14). Conclusion PFA for paroxysmal AF with PVI alone or PVI plus PWI produces similar sinus rhythm maintenance without affecting procedure times or complication rates.
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Junarta et al. (2026) conducted a cohort in Paroxysmal atrial fibrillation (n=249). Pulmonary vein isolation plus posterior wall isolation (PVI plus PWI) vs. Pulmonary vein isolation (PVI) alone was evaluated on Atrial tachyarrhythmia (ATA) recurrence at 1 year (p=0.92). Pulsed field ablation with PVI plus posterior wall isolation compared to PVI alone resulted in similar rates of atrial tachyarrhythmia recurrence at 1 year (16% vs. 16%; p=0.92).
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