Extent of posterior wall lesion following pulmonary vein isolation with pentaspline pulsed field and cryoballoon ablation: the potential role of deployment technique.
5 affiliations
- 1Department of Cardiology, Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid, Spain.
- 2Research Institute Hospital Universitario 12 de Octubre (I+12), Madrid, Spain.
- 3Department of Cardiology, Hospital Universitario de Getafe, Madrid, Spain.
- 4Centro de Investigación Biomedica en Red Cardiovascular (CIBERCV), Madrid, Spain.
- 5Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.
Abstract
Background
Pulmonary vein isolation (PVI) using cryoballoon (CB) or pulsed field ablation (PFA) with a pentaspline catheter achieves similar efficacy in atrial fibrillation (AF), but lesion extension on the left atrial posterior wall (LAPW) may differ. Pentaspline-PFA (P-PFA) has been reported to create broader LAPW lesions, potentially leaving narrow viable corridors that have been hypothesized to be proarrhythmic.Objective
To descriptively compare the extent of chronic unintended left atrial posterior wall isolation after PVI with P-PFA and CB ablation.Methods
We conducted a single-center ambispective study including consecutive patients undergoing repeat left atrial mapping after index PVI with either P-PFA, using a protocol designed to ensure catheter alignment with the pulmonary veins, or CB. Patients with additional LA ablation between index procedure and remapping, unrelated LAPW scarring, or posterior pulmonary vein gaps were excluded. The primary endpoint was isolated LAPW area. Secondary endpoints included percentage of isolated LAPW and minimum residual corridor width.Results
Seventy-four patients were included in the analysis: 49 P-PFA and 25 CB. Mean age was 64.2 ± 10.0 years, 64.9% were male, and 55.4% had persistent AF. Isolated LAPW area was 8.3 ± 4.0 cm² in the P-PFA group and 9.5 ± 3.9 cm² in the CB group, with no statistically significant difference detected between groups (mean difference -1.26 cm², 95% CI: -3.22 to 0.70; p = 0.203). The percentage of isolated LAPW area was 39.9 ± 17.6% vs. 38.9 ± 14.9% (p = 0.805), and minimum residual corridor width was 19.7 ± 9.9 vs. 18.6 ± 11.0 mm (p = 0.671), respectively. P-PFA was associated with shorter procedure time (44.2 ± 10.2 vs. 65.8 ± 24.6 min; p < 0.001), shorter LA dwell time (38.1 ± 9.6 vs. 60.6 ± 20.5 min; p < 0.001), lower fluoroscopy time (5.3 ± 3.9 vs. 13.0 ± 9.7 min; p < 0.001), and lower dose-area product [5.3 (2.8-9.7) vs. 19.3 (6.5-31.0) Gy·cm²; p < 0.001].Conclusion
In this descriptive, hypothesis-generating study, no statistically significant difference in chronic LAPW isolation extent was detected between P-PFA and CB ablation. These findings support the hypothesis that catheter deployment technique may influence posterior wall lesion geometry, warranting confirmation in adequately powered prospective studies.
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BibTeX
@article{cobarro2026extent,
title = {{Extent of posterior wall lesion following pulmonary vein isolation with pentaspline pulsed field and cryoballoon ablation: the potential role of deployment technique.}},
author = {Lucía Cobarro and Lorena Gómez-Burgueño and Martín Negreira-Caamaño and Isabel López-Alacid and Javier Ramos-Jiménez and Ez Alddin Rajjoub and Álvaro Marco-DelCastillo and Luis Borrego-Bernabé and Juan Delgado and Rafael Salguero-Bodes and Fernando Arribas-Ynsaurriaga and Daniel Rodríguez-Muñoz},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1880750},
url = {https://europepmc.org/article/MED/42908612},
note = {CC BY},
}
RIS
TY - JOUR
TI - Extent of posterior wall lesion following pulmonary vein isolation with pentaspline pulsed field and cryoballoon ablation: the potential role of deployment technique.
AU - Lucía Cobarro
AU - Lorena Gómez-Burgueño
AU - Martín Negreira-Caamaño
AU - Isabel López-Alacid
AU - Javier Ramos-Jiménez
AU - Ez Alddin Rajjoub
AU - Álvaro Marco-DelCastillo
AU - Luis Borrego-Bernabé
AU - Juan Delgado
AU - Rafael Salguero-Bodes
AU - Fernando Arribas-Ynsaurriaga
AU - Daniel Rodríguez-Muñoz
PY - 2026
DA - 2026/10/07
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1880750
UR - https://europepmc.org/article/MED/42908612
AB - Background Pulmonary vein isolation (PVI) using cryoballoon (CB) or pulsed field ablation (PFA) with a pentaspline catheter achieves similar efficacy in atrial fibrillation (AF), but lesion extension on the left atrial posterior wall (LAPW) may differ. Pentaspline-PFA (P-PFA) has been reported to create broader LAPW lesions, potentially leaving narrow viable corridors that have been hypothesized to be proarrhythmic.Objective To descriptively compare the extent of chronic unintended left atrial posterior wall isolation after PVI with P-PFA and CB ablation.Methods We conducted a single-center ambispective study including consecutive patients undergoing repeat left atrial mapping after index PVI with either P-PFA, using a protocol designed to ensure catheter alignment with the pulmonary veins, or CB. Patients with additional LA ablation between index procedure and remapping, unrelated LAPW scarring, or posterior pulmonary vein gaps were excluded. The primary endpoint was isolated LAPW area. Secondary endpoints included percentage of isolated LAPW and minimum residual corridor width.Results Seventy-four patients were included in the analysis: 49 P-PFA and 25 CB. Mean age was 64.2 ± 10.0 years, 64.9% were male, and 55.4% had persistent AF. Isolated LAPW area was 8.3 ± 4.0 cm² in the P-PFA group and 9.5 ± 3.9 cm² in the CB group, with no statistically significant difference detected between groups (mean difference -1.26 cm², 95% CI: -3.22 to 0.70; p = 0.203). The percentage of isolated LAPW area was 39.9 ± 17.6% vs. 38.9 ± 14.9% (p = 0.805), and minimum residual corridor width was 19.7 ± 9.9 vs. 18.6 ± 11.0 mm (p = 0.671), respectively. P-PFA was associated with shorter procedure time (44.2 ± 10.2 vs. 65.8 ± 24.6 min; p < 0.001), shorter LA dwell time (38.1 ± 9.6 vs. 60.6 ± 20.5 min; p < 0.001), lower fluoroscopy time (5.3 ± 3.9 vs. 13.0 ± 9.7 min; p < 0.001), and lower dose-area product [5.3 (2.8-9.7) vs. 19.3 (6.5-31.0) Gy·cm²; p < 0.001].Conclusion In this descriptive, hypothesis-generating study, no statistically significant difference in chronic LAPW isolation extent was detected between P-PFA and CB ablation. These findings support the hypothesis that catheter deployment technique may influence posterior wall lesion geometry, warranting confirmation in adequately powered prospective studies.
SN - 2297-055X
ER -