The Lead Episode 133: A Discussion of Feasibility and Safety of PFA for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation Acute and Chronic Findings (LIVE at APHRS 2025)-The Lead Episode 133 Bonus Video File

Video Transcription

Video Summary

In this episode of The Lead, experts discuss a study on the feasibility and safety of using the pentaspline pulse field ablation (PFA) system for targeting non-pulmonary vein areas—specifically the coronary sinus, left atrial appendage, and mitral isthmus—in atrial fibrillation (AF) ablation. While acute isolation success was high (100% for appendage and mitral isthmus, 61% for coronary sinus), chronic durability was poor, with only 1-5% maintaining isolation after three months. The trial revealed limitations of the current PFA catheter design, especially for thicker, epicardial-involved tissues, and underscored the need for tailored approaches and further evaluation of other PFA platforms. Both discussants continue to prioritize PFA for pulmonary vein and posterior wall ablation, relying on radiofrequency for other substrates. The study raises questions on the clinical value and optimal energy delivery for these advanced targets, emphasizing cautious interpretation and the ongoing role of traditional ablation methods.

Keywords

pentaspline pulse field ablation

atrial fibrillation ablation

non-pulmonary vein targets

coronary sinus ablation

ablation durability