Pulsed field ablation for the treatment of atrial fibrillation aided by intracardiac echocardiography to achieve pulmonary vein isolation with anchor lesion formation - feasibility and one-year outcomes

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Paroxysmal and persistent atrial fibrillation (n=100). Intervention: Pulsed field ablation guided by intracardiac echocardiography with anchor lesion formation. Primary outcome: 1-year atrial fibrillation recurrence-free survival.

Andrija Nekić; Vedran Pašara; Ivan Prepolec; Zvonimir Katić; Davor Miličić; Vedran Velagić

doi:10.15836/ccar2026.231

November 1, 2026Cardiologia CroaticaOpen Access

Pulsed field ablation for the treatment of atrial fibrillation aided by intracardiac echocardiography to achieve pulmonary vein isolation with anchor lesion formation - feasibility and one-year outcomes

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Key result

ICE-guided pulsed field ablation yields ~81% 1-year AF recurrence-free survival with no major adverse events.

n=100

Why the study?

Does pulsed field ablation using a pentaspline catheter guided by intracardiac echocardiography with anchor lesion formation achieve pulmonary vein isolation and prevent arrhythmia recurrence at one year in patients with paroxysmal and persistent atrial fibrillation?

Key Points

To evaluate the procedural feasibility, safety, and one-year clinical outcomes of pulsed field ablation guided by intracardiac echocardiography with anchor lesion formation for atrial fibrillation.
Retrospective single-center analysis of 100 consecutive patients with paroxysmal (49.0%) or persistent (51.0%) atrial fibrillation treated between April 2023 and November 2024.
Ablation was performed using a pentaspline catheter guided by fluoroscopy and intracardiac echocardiography, applying anterior anchor lesions in all patients and posterior anchor lesions in those receiving posterior wall ablation.
Follow-up occurred at 3, 6, and 12 months using 24-hour Holter electrocardiography and phone calls.
Complete pulmonary vein isolation was achieved in 100% of patients with a mean procedure duration of 51.2 ± 16.6 minutes and a mean of 56.9 ± 15.0 applications; 54% received additional posterior wall ablation.
At one-year follow-up, total arrhythmia recurrence-free survival was 81.0%, with recurrence observed in 7% of paroxysmal versus 12% of persistent cases (p=0.239).
No major adverse events occurred during the procedural or follow-up period.

Study Design

Type

Observational (n=100)

Multicenter

No

Structured PICO

Does pulsed field ablation using a pentaspline catheter guided by intracardiac echocardiography with anchor lesion formation achieve pulmonary vein isolation and prevent arrhythmia recurrence at one year in patients with paroxysmal and persistent atrial fibrillation?

P

Population

100 patients (mean age 61.9 years, 31.0% female) with paroxysmal or persistent atrial fibrillation undergoing intracardiac echocardiography-guided pulsed field ablation at a single Croatian center, followed for 1 year.

I

Intervention

Pulsed field ablation using a pentaspline catheter guided by both diascopy and intracardiac echocardiography to achieve pulmonary vein isolation with anterior anchor lesion formation in all cases, and additional posterior wall ablation with posterior anchor lesions in 54% of patients.

O

Outcome

Atrial fibrillation recurrence-free survival at one-year follow-up (evaluated via 3-, 6-, and 12-month visits with 24-hour Holter EKG and phone calls).surrogate

Intracardiac echocardiography-guided pulsed field ablation with anchor lesion formation demonstrated high acute procedural success (100% pulmonary vein isolation), a strong safety profile with zero major adverse events, and an 81.0% one-year AF recurrence-free survival rate in a mixed paroxysmal and persistent AF cohort.

Limitations

Retrospective, single-center analysis
Single-arm design without a control group
Relatively small sample size (N=100)
Retrospective design
Single-center analysis

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Implication

Supports ICE-guided PFA feasibility; leaves open randomized validation of efficacy and safety.

Abstract

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Discussion

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Cite This Study

Nekić et al. (2026) conducted an observational in Paroxysmal and persistent atrial fibrillation (n=100). Pulsed field ablation guided by intracardiac echocardiography with anchor lesion formation was evaluated on 1-year atrial fibrillation recurrence-free survival. Pulsed field ablation guided by intracardiac echocardiography achieved 100% pulmonary vein isolation and 81.0% 1-year atrial fibrillation recurrence-free survival with no major adverse events.

synapsesocial.com/papers/6af5db460766bb45ea003117 https://doi.org/10.15836/ccar2026.231

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Pulsed field ablation for the treatment of atrial fibrillation aided by intracardiac echocardiography to achieve pulmonary vein isolation with anchor lesion formation - feasibility and one-year outcomes

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Pulsed field ablation for the treatment of atrial fibrillation aided by intracardiac echocardiography to achieve pulmonary vein isolation with anchor lesion formation - feasibility and one-year outcomes

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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