What does this research mean for the field?

Using 20 pulsed-field ablation (PFA) applications increases the first-pass mitral isthmus (MI) block success rate to 70% compared to 33.3% with 9 applications. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the acute efficacy of mitral isthmus ablation using a pentaspline catheter and two different ablation settings.

January 10, 2026Journal of Cardiovascular Electrophysiology0 citationsOpen Access

Acute Efficacy of Pulsed‐Field Ablation of the Mitral Isthmus Using a Pentaspline Catheter and Two Different Ablation Settings

JHJosef HornofCharles University MHMarek HozmanElectrophysiology DHDalibor HeřmanElectrophysiology

Key Result

Using 20 PFA applications increased the first-pass MI block success to 70% compared to 33.3% in patients receiving 9 applications.

Key Points

To evaluate the acute efficacy of mitral isthmus ablation using a pentaspline catheter and two different ablation settings.
Enrolled patients with atrial fibrillation undergoing ablation sequentially.
Performed pulmonary vein isolation and left atrial posterior wall ablation prior to mitral isthmus ablation.
Conducted up to 4 series of pulsed-field ablation applications in Cohort A and 3 series in Cohort B with differing application doses.
Achieved a first-pass mitral isthmus block in 33.3% of patients in Cohort A and 70% in Cohort B.
Final mitral isthmus block present in 90% of Cohort A and 87.5% of Cohort B patients.
Median reconduction times were similar in both cohorts with no major complications reported.

Structured PICO

Does increasing pulsed-field ablation applications from 9 to 20 per series improve the rate of first-pass durable mitral isthmus block in patients with non-paroxysmal atrial fibrillation?

Population

70 consecutive patients with symptomatic non-paroxysmal atrial fibrillation (AF) undergoing a first-ever left atrial ablation procedure (Cohort A n=30, Cohort B n=40). Mean age ~68 years, ~37% female, based in the Czech Republic. Key exclusions: LVEF < 30%, prior left atrial catheter ablation, and clinical conditions posing increased risk during prolonged analgosedation (stage III/IV COPD or treated obstructive sleep apnea).

Intervention

Mitral isthmus (MI) ablation using a pentaspline pulsed-field ablation (PFA) catheter with 20 PFA applications per series (16 in flower configuration, 4 in basket configuration), added to pulmonary vein isolation and left atrial posterior wall ablation (Cohort B).

Comparator

Mitral isthmus (MI) ablation using a pentaspline pulsed-field ablation (PFA) catheter with 9 PFA applications per series (flower configuration), added to pulmonary vein isolation and left atrial posterior wall ablation (Cohort A).

Outcome

First-pass durable bidirectional mitral isthmus conduction block following a 20-minute observation period, and final durable mitral isthmus block after all ablation series.surrogate

Increasing the number of pulsed-field ablation applications from 9 to 20 per series significantly improves the acute success rate of first-pass durable mitral isthmus block in patients with non-paroxysmal atrial fibrillation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT Introduction There is limited data regarding the use of pulsed‐field ablation (PFA) for mitral isthmus (MI) ablation in patients with non‐paroxysmal atrial fibrillation (AF). Our aim was to assess the acute efficacy of MI ablation using a pentaspline PFA catheter with two different ablation settings. Methods Patients with AF undergoing ablation were consecutively enrolled. All patients underwent pulmonary vein isolation and left atrial posterior wall ablation. MI ablation was performed in up to 4 series (9 PFA applications each) in Cohort A, or in up to 3 series (20 PFA applications each) in Cohort B. Each series was followed by a 20‐min observation period to verify the durability of the MI block. The primary endpoints were a first‐pass MI block and a final MI block after all ablation series. Results Between September 2024 and June 2025, 70 patients were enrolled: 30 in Cohort A and 40 in Cohort B. A first‐pass MI block was achieved in 10 (33.3%) patients in Cohort A and 28 (70%) patients in Cohort B ( p = 0.003). A final MI block was present in 27 (90%) and 35 (87.5%) patients in Cohort A and B, respectively ( p = 1.00). The median reconduction time was 6 min (IQR 2.8–9.4) in Cohort A and 5 min (IQR 2.6–8.7) in Cohort B. No major complications occurred. Conclusion Using series of 20 PFA applications increased the success rate of a first‐pass MI block to 70%. An observation period is recommended to verify the durability of MI block in PFA. Clinical Trial Registration: NCT06803238.

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