What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=200). Intervention: Pentaspline pulsed field ablation catheter vs. Circular array pulsed field ablation catheter. Primary outcome: Freedom from atrial arrhythmia after a 3-month blanking period (p=0.90).

What does this research mean for the field?

Pentaspline and circular pulsed field ablation catheters demonstrate comparable 1-year arrhythmia-free survival (81.7% vs 81.8%) and safety for pulmonary vein isolation with adjunctive atrial lines. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study compares the 1-year outcomes of pentaspline and circular PFA catheters for pulmonary vein isolation with adjunctive left atrial ablation.

April 17, 2026Open Access

Comparative 1-Year Outcomes of Pentaspline versus Circular Array Pulsed Field Ablation for Pulmonary Vein Isolation with Adjunctive Atrial Lines

Key Result

Pentaspline and circular pulsed field ablation catheters demonstrated comparable 1-year arrhythmia-free survival (81.7% vs 81.8%) for pulmonary vein isolation with adjunctive atrial lines.

Key Points

This study compares the 1-year outcomes of pentaspline and circular PFA catheters for pulmonary vein isolation with adjunctive left atrial ablation.
Included 200 consecutive patients undergoing PVI with either pentaspline or circular PFA catheter between November 2023 and 2024.
Performed additional left atrial roof line ablation in persistent AF patients with left atrial enlargement.
Measured freedom from atrial arrhythmia after a 3-month blanking period as the primary endpoint.
1-year arrhythmia-free survival was similar: 81.7% for pentaspline vs. 81.8% for circular PFA (log-rank P=0.90).
Acute PVI and bidirectional block were achieved in 100% of cases in both groups.
Overall complication rates were low and comparable (5% vs. 3%).

Study Design

Type

Observational (n=200)

Multicenter

Structured PICO

Does pentaspline pulsed field ablation compared to circular pulsed field ablation improve freedom from atrial arrhythmia in patients undergoing pulmonary vein isolation?

Population

200 consecutive patients undergoing first-time catheter ablation for atrial fibrillation (65% male, 44% persistent AF, median age 66). Exclusions: intracardiac thrombus, previous left atrial ablation, significant valvular heart disease, or pregnancy.

Intervention

Pentaspline pulsed field ablation catheter for pulmonary vein isolation (with additional left atrial roof line ablation for persistent AF with LA >20 cm2, or cavotricuspid isthmus ablation for typical atrial flutter)

Comparator

Circular pulsed field ablation catheter for pulmonary vein isolation (with additional left atrial roof line ablation for persistent AF with LA >20 cm2, or cavotricuspid isthmus ablation for typical atrial flutter)

Outcome

Any documented recurrence of atrial tachyarrhythmias (atrial fibrillation, atrial flutter, or atrial tachycardia) lasting ≥30 seconds after a 3-month blanking periodcomposite

Pentaspline and circular pulsed field ablation catheters demonstrate comparable 1-year clinical efficacy and safety for pulmonary vein isolation and adjunctive atrial lines.

Main Result

Absolute Event Rate: 81.7% vs 81.8%

p-value: p=0.90

Limitations

Observational, single-center analysis without randomization
Relatively small sample size
PV anatomy delineated using angiography rather than intracardiac echocardiography
Continuous rhythm monitoring was not performed, relying on 12-lead ECGs and intermittent Holter monitoring
Sequential implementation of the two PFA systems may introduce residual era bias

Abstract

BACKGROUND Pulsed field ablation (PFA) has emerged as an effective and safe single-shot technology for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, comparative long-term outcome data between different PFA catheter designs, particularly for additional atrial ablation beyond PVI, remain scarce. OBJECTIVE This study aimed to compare 1-year clinical outcomes and procedural performance of pentaspline versus circular PFA catheters for PVI with additional left atrial roof line ablation (LARA). METHODS Consecutive patients undergoing fluoroscopy-guided PVI using either a pentaspline or circular PFA catheter between November 2023 and November 2024 were included. LARA was performed in patients with persistent AF and left atrial enlargement (LA area >20 cm 2). The primary end point was freedom from atrial arrhythmia after a 3-month blanking period. RESULTS A total of 200 patients were included (65% male, 44% persistent AF, median age 66 interquartile range IQR 59-74 years), with 100 patients per group and no baseline differences. LARA was performed in 30% (30/100) of pentaspline and 32% (32/100) of circular PFA procedures, respectively. Acute PVI and bidirectional block of all additional lines were achieved in 100% of cases. Median procedure time (63 IQR 54-77 vs 67 IQR 59-80 min; P 5. 06) and fluoroscopy time (11. 9 9. 8-15. 2vs 13. 2 10. 2-15. 9min; P 5. 203) were comparable. Overall complication rates were low and similar (5% vs 3%). During a median follow-up of 386 (IQR 349-486) days, 1-year arrhythmia-free survival was similar between pentaspline and circular PFA catheters (81. 7% vs 81. 8%; log-rank P 5. 90), with comparable outcomes in paroxysmal and persistent AF. CONCLUSION Pentaspline and circular PFA catheters demonstrate comparable safety, procedural performance, and 1-year clinical efficacy for PVI and LARA. These findings support the feasibility of comprehensive PFA-based atrial ablation strategies in patients with persistent atrial fibrillation and enlarged left atria.

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