Acute outcomes of cryoballoon vs. circular vs. pentaspline pulsed-field ablation catheters in combined pulmonary vein isolation and roof line ablation

Background Single-shot ablation systems are widely used for pulmonary vein isolation (PVI) in atrial fibrillation (AF). The use of novel pulsed-field ablation (PFA) systems enables ablation beyond PVI, such as left atrial roof ablation (LARA), which may improve outcomes in persistent AF. Objective This study aimed to compare the acute efficacy, feasibility, and safety of PVI combined with LARA using three different single-shot ablation systems in patients with persistent AF and left atrial enlargement undergoing their first AF ablation. MethodsConsecutive patients undergoing PVI with LARA using cryoballoon or PFA systems were included. Baseline characteristics, procedural parameters, and complication rates were assessed. Results We included 125 patients with persistent AF and left atrial dilation, divided into cryoballoon (n = 65), pentaspline PFA (n = 30), and circular PFA (n = 30) groups. Acute PVI was achieved in 100% of veins. Fewer applications were required for LARA with cryoballoon vs. PFA (4 vs. 8 vs. 10, P < 0.001). Conduction block was confirmed in 95%, 100%, and 100% of patients (P = 0.421). Procedural times were longer with cryoballoon (87.0 vs. 64.0 vs. 68.0 min, P < 0.001), but fluoroscopy times were shorter (12.2 vs. 15.3 vs. 15.1 min, P = 0.002). Contrast medium use was higher in the cryoballoon group (P < 0.001). Adverse events were rare and predominantly minor, with three complications in the cryoballoon group and one in the PFA groups (P = 0.493). Conclusion All single-shot ablation systems demonstrated comparable efficacy and safety for PVI and LARA, with differences in procedural feasibility. Further and larger studies are needed.