September 8, 2026Journal of Cardiovascular Electrophysiology0 citations
The Pear Strategy for Two‐Ring Pulmonary Vein Isolation: Antral and Sleeve Ablation Using a Balloon‐in‐Basket Pulsed Field Ablation Catheter
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Key Result
The pear two-step strategy using a balloon-in-basket pulsed field ablation catheter achieved successful pulmonary vein isolation in 100% of 50 patients with atrial fibrillation.
Key Points
- To describe and evaluate the clinical adoption, acute efficacy, safety, and workflow optimization of a novel balloon-in-basket pulsed field ablation catheter using a two-step pear strategy for pulmonary vein isolation.
- Consecutive all-comer patients with atrial fibrillation (N=50; 62% paroxysmal, 42% female, mean age 68 ± 10 years) underwent pulsed field ablation under deep sedation.
- A two-step pear workflow was implemented: four antral pulsed field ablation applications guided by pulmonary vein angiography, followed by two distal pear-shaped balloon applications targeting pulmonary vein sleeves using 3D electroanatomic mapping.
- Acute pulmonary vein isolation was achieved in 100% of targeted pulmonary veins across all 50 patients.
- Median procedure duration was 50 min (IQR 41–50) and fluoroscopy time was 7.2 min (IQR 5.8–11.4), with no significant learning curve effect between the first and second 25 patients (50 vs. 47 min, p = 0.26).
- No major or minor procedural complications occurred; transient phrenic nerve stunning developed in two patients (4%) and resolved prior to procedure completion.
Study Design
Type
Observational (n=50)
Structured PICO
Does a two-step pear strategy using a balloon-in-basket PFA catheter achieve safe and efficient pulmonary vein isolation in patients with atrial fibrillation?
P
Population
50 consecutive all-comer patients with atrial fibrillation undergoing pulmonary vein isolation using a balloon-in-basket pulsed field ablation catheter.
E
Exposure
Pulmonary vein isolation using a balloon-in-basket pulsed field ablation (PFA) catheter with a two-step 'pear' strategy (4 antral applications and 2 distal sleeve applications) under deep sedation.
O
Outcome
Procedural parameters, acute efficacy (successful pulmonary vein isolation), and safety.
The two-step 'pear' strategy using a balloon-in-basket PFA catheter provides rapid, effective, and safe acute pulmonary vein isolation for patients with atrial fibrillation.
Abstract
BACKGROUND: Pulsed field ablation (PFA) has emerged as a promising energy source for atrial fibrillation (AF) catheter ablation. This study aimed to describe the adoption and workflow optimization of a novel balloon-in-basket PFA catheter using a two rings balloon and pear strategy for pulmonary vein isolation (PVI), the pear workflow. METHODS: Consecutive all-comer patients with AF underwent PFA using the balloon-in-basket PFA catheter under deep sedation. The pear workflow comprised a two-step PVI protocol: (1) four antral PFA applications guided by initial PV angiography to confirm PV occlusion and lesion overlap through rotational deployment, followed by (2) two distal, pear-shaped balloon applications targeting the PV sleeves. Three-dimensional electroanatomic mapping with impedance-based contact assessment was utilized. Procedural parameters, acute efficacy, and safety were analyzed. RESULTS: Fifty patients (62% paroxysmal AF, 42% female, mean age 68 ± 10 years) were enrolled. All PVs were successfully isolated. Median procedural and fluoroscopy times were 50 min (IQR 41-50) and 7.2 min (IQR 5.8-11.4), respectively, without significant change over the study course (50 vs. 47 min for patients 1-25 and 26-50, respectively, p = 0.26). Additional ablation was performed in four patients, and concomitant left atrial appendage closure was performed in three. No major or minor complications occurred. Transient phrenic nerve stunning was observed in two patients, resolving before procedure completion. CONCLUSION: The pear two-step strategy enables rapid, efficient, and safe PVI using a balloon-in-basket PFA catheter, which, despite its anatomically based design, offers procedural versatility through integrated mapping with a minimal learning curve.
Cite This Study
Gunawardene et al. (2026) conducted an observational in Atrial fibrillation (n=50). Balloon-in-basket pulsed field ablation catheter (pear strategy) was evaluated on Successful pulmonary vein isolation. The pear two-step strategy using a balloon-in-basket pulsed field ablation catheter achieved successful pulmonary vein isolation in 100% of 50 patients with atrial fibrillation.