Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec 27.
doi: 10.1111/jce.70236. Online ahead of print.

Acute Efficacy of Pulsed-Field Ablation of the Mitral Isthmus Using a Pentaspline Catheter and Two Different Ablation Settings

Josef Hornof  1 , Marek Hozman  1   2 , Dalibor Heřman  1   2 , Oleksii Romanenko  3 , Sabri Hassouna  1   2 , Jana Veselá  1   2 , Věra Filipcová  1 , Lukáš Povišer  1   2 , Jakub Karch  1 , Jana Hozmanová  1   2 , Lucie Znojilová  1   2 , Anna Molová  3 , Vojtěch Pěnkava  3 , Pavel Osmančík  1   2
Affiliations

Acute Efficacy of Pulsed-Field Ablation of the Mitral Isthmus Using a Pentaspline Catheter and Two Different Ablation Settings

Josef Hornof et al. J Cardiovasc Electrophysiol. .

Abstract

Introduction: There is limited data regarding the use of pulsed-field ablation (PFA) for mitral isthmus (MI) ablation in patients with non-paroxysmal atrial fibrillation (AF). Our aim was to assess the acute efficacy of MI ablation using a pentaspline PFA catheter with two different ablation settings.

Methods: Patients with AF undergoing ablation were consecutively enrolled. All patients underwent pulmonary vein isolation and left atrial posterior wall ablation. MI ablation was performed in up to 4 series (9 PFA applications each) in Cohort A, or in up to 3 series (20 PFA applications each) in Cohort B. Each series was followed by a 20-min observation period to verify the durability of the MI block. The primary endpoints were a first-pass MI block and a final MI block after all ablation series.

Results: Between September 2024 and June 2025, 70 patients were enrolled: 30 in Cohort A and 40 in Cohort B. A first-pass MI block was achieved in 10 (33.3%) patients in Cohort A and 28 (70%) patients in Cohort B (p = 0.003). A final MI block was present in 27 (90%) and 35 (87.5%) patients in Cohort A and B, respectively (p = 1.00). The median reconduction time was 6 min (IQR 2.8-9.4) in Cohort A and 5 min (IQR 2.6-8.7) in Cohort B. No major complications occurred.

Conclusion: Using series of 20 PFA applications increased the success rate of a first-pass MI block to 70%. An observation period is recommended to verify the durability of MI block in PFA.

Clinical trial registration: NCT06803238.

Keywords: atrial fibrillation; mitral isthmus ablation; pentaspline catheter; pulsed‐field ablation; reconduction.

PubMed Disclaimer

References

    1. C. Sang, Q. Liu, Y. Lai, et al., “Pulmonary Vein Isolation With Optimized Linear Ablation vs Pulmonary Vein Isolation Alone for Persistent AF: The PROMPT‐AF Randomized Clinical Trial,” Journal of the American Medical Association 333, no. 5 (2025): 381–389, https://doi.org/10.1001/JAMA.2024.24438.
    1. T. Takagi, N. Derval, J. Duchateau, et al., “Gaps After Linear Ablation of Persistent Atrial Fibrillation (Marshall‐PLAN): Clinical Implication,” Heart Rhythm 20, no. 1 (2023): 14–21, https://doi.org/10.1016/J.HRTHM.2022.09.009.
    1. D. M. Luria, J. Nemec, S. P. Etheridge, et al., “Intra‐Atrial Conduction Block Along the Mitral Valve Annulus During Accessory Pathway Ablation: Evidence for a Left Atrial ‘Isthmus,” Journal of Cardiovascular Electrophysiology 12, no. 7 (2001): 744–749, https://doi.org/10.1046/J.1540-8167.2001.00744.X.
    1. A. E. Becker, “Left Atrial Isthmus:: Anatomic Aspects Relevant for Linear Catheter Ablation Procedures in Humans,” Journal of Cardiovascular Electrophysiology 15, no. 7 (2004): 809–812, https://doi.org/10.1046/J.1540-8167.2004.03651.X.
    1. P. Jaïs, M. Hocini, L. F. Hsu, et al., “Technique and Results of Linear Ablation at the Mitral Isthmus,” Circulation 110, no. 19 (2004): 2996–3002, https://doi.org/10.1161/01.CIR.0000146917.75041.58.

Associated data

LinkOut - more resources