Acute efficacy of a focal dual-energy contact force-sensing catheter vs. standard radiofrequency for anatomical ablation of persistent atrial fibrillation: a pilot study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Persistent atrial fibrillation (n=40). Intervention: Pulsed-field and radiofrequency ablation (STSF-DE catheter) vs. Radiofrequency ablation alone (RF-only STSF catheter). Primary outcome: First-pass block of the complete set (PVI, dome, mitral isthmus, and CTI) (p=0.006).

Francesco Notaristefano; Nicolas Johner; Geoffroy Ditac; Allan Plant; Laurens Verhaeghe; John Leonard Fitzgerald; Kinan Kneizeh; Karim Bénali; Konstantinos George Vlachos; Cinzia Monaco; Benjamin Sacristan; Jan Charton; Léa Benabou; Marianne Tétreault‐Langlois; Josselin Duchâteau; Frédéric Sacher; Romain Tixier; Mélèze Hocini; Pierre Jaı̈s; Michel Haı̈ssaguerre; Thomas Pambrun; Nicolas Derval

doi:10.1093/europace/euag196

Key result

Combined PFA and RF ablation linked to ~45-point higher first-pass complete block vs. RF alone.

P=0.006
n=40

Figures

Why the study?

Does a dual-energy (PFA and RF) contact force-sensing catheter improve first-pass and final block of a complete anatomical lesion set compared to standard radiofrequency ablation in patients with persistent atrial fibrillation?

Key Points

To assess the acute efficacy and procedural performance of a focal dual-energy contact force-sensing catheter toggling between radiofrequency and pulsed field ablation compared with standard radiofrequency.
Enrolled 40 consecutive patients undergoing first-time persistent atrial fibrillation ablation, allocated to standard radiofrequency (RF group, n=20) or dual-energy pulsed field ablation plus RF (PF group, n=20).
Applied the Marshall-Plan lesion set (pulmonary vein isolation, dome line, mitral line, cavo-tricuspid isthmus line, and vein of Marshall ethanol infusion), with 90% of procedures performed under local anaesthesia.
First-pass block rates were significantly higher in the PF group for the complete lesion set (55% vs. 10%, P = 0.006), pulmonary vein isolation (85% vs. 50%, P = 0.041), and pulmonary vein isolation plus dome block (80% vs. 40%, P = 0.022).
Final block rates were similar between the PF and RF groups for the complete lesion set (90% vs. 75%), pulmonary vein isolation (100% vs. 100%), and pulmonary vein isolation plus dome block (90% vs. 75%, P = ns).
Total procedure duration was similar between groups (194 ± 23 min vs. 191 ± 21 min), with one circumflex artery spasm occurring during coronary sinus pulsed field ablation.

Study Design

Type

Observational (n=40)

Structured PICO

Does a dual-energy (PFA and RF) contact force-sensing catheter improve first-pass and final block of a complete anatomical lesion set compared to standard radiofrequency ablation in patients with persistent atrial fibrillation?

P

Population

40 consecutive patients undergoing first-time persistent atrial fibrillation ablation.

E

Exposure

Pulsed-field ablation (PFA) combined with radiofrequency (RF) using a point-by-point contact force-sensing dual-energy catheter (SmartTouch SF dual-energy) following the Marshall-Plan strategy (PVI, lines, and upfront vein of Marshall ethanol infusion)

C

Comparator

Radiofrequency (RF) ablation alone using an RF-only STSF ablation catheter following the same anatomical Marshall-Plan strategy

O

Outcome

Rates of first-pass and final block of the complete set (PVI, dome, mitral isthmus, and cavo-tricuspid isthmus)surrogate

Main Result

Absolute Event Rate: 55% vs 10%

p-value: p=0.006

A dual-energy contact force-sensing catheter combining PFA and RF for persistent AF ablation is feasible and acutely safe under local anesthesia, yielding higher first-pass block rates than standard RF ablation.

Limitations

Coronary artery spasm risk with pulsed field ablation close to coronary arteries
Pulsed field ablation demonstrated similar anatomical limitations to radiofrequency at the mitral isthmus

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Implication

May enhance acute lesion durability in persistent AF ablation; leaves open randomized confirmation of clinical outcomes.

Abstract

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Cite This Study

Notaristefano et al. (2026) conducted an observational in Persistent atrial fibrillation (n=40). Pulsed-field and radiofrequency ablation (STSF-DE catheter) vs. Radiofrequency ablation alone (RF-only STSF catheter) was evaluated on First-pass block of the complete set (PVI, dome, mitral isthmus, and CTI) (p=0.006). Pulsed-field combined with radiofrequency ablation yielded a higher rate of first-pass complete lesion set block compared to radiofrequency alone (55% vs. 10%, P=0.006).

synapsesocial.com/papers/6ad115ba00741cc3fba7d8b2 https://doi.org/10.1093/europace/euag196

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Acute efficacy of a focal dual-energy contact force-sensing catheter vs. standard radiofrequency for anatomical ablation of persistent atrial fibrillation: a pilot study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Acute efficacy of a focal dual-energy contact force-sensing catheter vs. standard radiofrequency for anatomical ablation of persistent atrial fibrillation: a pilot study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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