ABSTRACT Background Recently, multiple pulsed field ablation (PFA)‐system were introduced for catheter ablation (CA) of atrial fibrillation (AF). However, data comparing procedural performance, the extent of low‐voltage areas (LVA), and myocardial injury between different PFA‐systems in a real‐world setting remain scarce. Methods Consecutive patients undergoing CA for AF were enrolled. PFA was performed using either a Pentaspline catheter‐system (PCS) or a loop catheter‐system (LCS). The extent of acute antral LVA was assessed using a 3D‐electroanatomical mapping system. High‐sensitivity cardiac troponin T (hs‐cTnT) was measured the day after the procedure to assess myocardial injury. Results A total of 120 patients (median age 67 59–73 years, 29% female) underwent de novo pulmonary vein isolation (PVI). The PCS‐group included 90 patients, while the LCS‐group included 30 patients. Acute PVI was achieved in all patients (100%). Procedural times were significantly shorter in the PCS compared to the LCS‐group, including total procedure duration (57 48–67 vs 66 52–83 min, p = 0.016), left atrial dwell time (38 32–48 vs 54 38–65 min, p < 0.001), and ablation duration (17 12–23 vs 24 20–33 min, p < 0.001). Acute antral LVA and myocardial injury were significantly lower in the PCS compared to the LCS‐group (6.6 5.0–8.9 vs. 19.2 16.8–25.4 cm², p < 0.001 and hs‐cTnT of 1282 892–1894 vs 1588 1281–2110 ng/L, p = 0.029. Conclusion Significant differences were observed between two commercially available PFA‐systems. While PCS was associated with significantly shorter procedural time, LCS resulted in a greater extent of acute antral LVA and myocardial injury levels.
Subin et al. (2025) studied this question.