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.

Methods: Consecutive 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.