Left atrial posterior wall isolation using pulsed-field ablation: procedural characteristics, safety, and mid-term outcomes

Background Non-pulmonary vein (PV) ablation targets such as posterior wall isolation (PWI) have been tested in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) offers a novel ablation technology possibly able to overcome the obstacles of incomplete PWI and concerns of damage to adjacent structures compared to thermal energy sources. Our aim was to assess procedural characteristics, safety, and mid-term outcomes of patients undergoing PWI using PFA in a clinical setting. Methods Patients undergoing PFA-PVI with PWI were included. First-pass isolation was controlled using a multipolar mapping catheter. Results One hundred consecutive patients were included (median age 69 [IQR 63–75] years, 33 females (33%), left atrial size 43 [IQR 39–47] mm, paroxysmal AF 24%). Median procedure time was 66 (IQR 59–77) min, and fluoroscopy time was 11 (8–14) min. PWI using PFA was achieved in 100% of patients with a median of 19 applications (IQR 14–26). There were no major complications. Overall, in 15 patients (15%), recurrent AF/AT was noted during a median follow-up of 144 (94–279) days. Conclusions PWI using PFA appears safe and results in high acute isolation rates and high arrhythmia survival during mid-term follow-up. Further randomized trials are essential and warranted. Graphical abstract