Heart Rhythm. 2026 May 15:S1547-5271(26)02385-4. doi: 10.1016/j.hrthm.2026.05.018. Online ahead of print.
ABSTRACT
BACKGROUND: Durable pulmonary vein isolation (PVI) is considered the "Achilles' heel" of atrial fibrillation (AF) ablation. While pulsed field ablation (PFA) is increasingly utilized due to its non-thermal, tissue-selective properties, comparative data regarding chronic lesion durability across different PFA platforms remain limited.
OBJECTIVE: To compare chronic PVI durability and PV reconnection patterns following index ablation with FARAPULSE (pentaspline) and VOLT (balloon-in-basket) catheters.
METHODS: We retrospectively reviewed consecutive patients undergoing repeat ablation at two centers (May 2023 and September 2025) following a de novo PFA procedure using either pentaspline (n=86) or balloon-in-basket catheter (n=46). High-density voltage mapping was employed to assess the PV and posterior wall (PW). Endpoints included lesion durability and vein reconnection rates. A propensity score-matched sensitivity analysis (n=34 pairs) addressed baseline imbalances.
RESULTS: Over a median follow-up of 14.3 months (IQR 5.9-18.9), 18 patients (9 in each group) experienced clinical recurrence, of which 17 patients underwent repeat procedures (balloon-in-basket n=9, pentaspline n=8). PV-level reconnection was 2.9% (1/35) with balloon-in-basket versus 28.1% (9/32) with pentaspline catheter (p=0.003). Patient-level durability was significantly higher with balloon-in-basket (88.9% vs 37.5%, p=0.049). Despite superior lesion durability, the balloon-in-basket cohort had a numerically higher but non-significant clinical recurrence rate (19.6% vs 10.5%, p=0.12), as confirmed by equivalent recurrence rates in the propensity-matched cohort (20.6% vs 17.6%, p=1.000). PWI was associated with significantly lower arrhythmia recurrence across the combined cohort (4.3% vs 17.6%, p=0.031).
CONCLUSION: The balloon-in-basket PFA platform demonstrated significantly greater chronic PVI durability compared with pentaspline system. A propensity score-matching confirmed that this durability advantage was not attributable to baseline substrate differences. These platform-specific differences are clinically meaningful and warrant prospective validation.
PMID:42142855 | DOI:10.1016/j.hrthm.2026.05.018