Evidence map›Paper›PMID 41609948›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026

Roof-dependent atrial tachycardia after pulsed field ablation-mechanistic insights and predictive modeling for optimized ablation strategies: an ultra-high-density mapping study.

Sebastian Feickert, Niels Christian Ewertsen, Kristof Biernath, Burak Duymaz, Hüseyin Ince, Jasmin Ortak, Giuseppe D'Ancona

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Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Sebastian FeickertDepartment of Cardiology and Internal Intensive Care Unit, Berlin Heartrhythm Center, Vivantes Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin-Kreuzberg, Germany. sebastian.feickert@vivantes.de.ORCID http://orcid.org/0000-0003-1747-298X
Niels Christian EwertsenDepartment of Cardiology and Internal Intensive Care Unit, Berlin Heartrhythm Center, Vivantes Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin-Kreuzberg, Germany.
Kristof BiernathDepartment of Cardiology and Internal Intensive Care Unit, Berlin Heartrhythm Center, Vivantes Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin-Kreuzberg, Germany.
Burak DuymazDepartment of Cardiology and Internal Intensive Care Unit, Berlin Heartrhythm Center, Vivantes Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin-Kreuzberg, Germany.
Hüseyin InceDepartment of Cardiology and Internal Intensive Care Unit, Berlin Heartrhythm Center, Vivantes Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin-Kreuzberg, Germany.
Jasmin OrtakDepartment of Cardiology, University Medical Center Rostock, Rostock, Germany.
Giuseppe D'AnconaDepartment of Cardiology and Internal Intensive Care Unit, Berlin Heartrhythm Center, Vivantes Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin-Kreuzberg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsPulsed field ablation (PFA) has emerged to an innovative approach to achieve pulmonary vein isolation (PVI) in atrial fibrillation (AF) treatment. Despite its fast adoption and promising safety profile, insights into immediate ablation effects and lesion characteristics and their influence on follow-up arrhythmia recurrence using ultra-high-density mapping (UHDM) are sparse. This study aims to evaluate acute lesion dynamics and formation and their clinical impact using UHDM.

methodsThis study enrolled 204 patients undergoing PVI with a pentaspline PFA system. UHDM was used for pre- and post-ablation assessment of the pulmonary veins (PV) and left atrium (LA). Clinical and mapping data were analyzed to define immediate lesion formation. Machine learning (ML) techniques, including SMOTE for data augmentation, were utilized to predict the recurrence of atrial tachycardia during follow-up and understand their underlying mechanisms.

resultsUHDM of immediate outcomes showed typical isolation patterns around the PV ostia. UHDM revealed a significantly narrowed electrically intact bridge on the LA roof. Furthermore, UHDM detected 14 non-isolated PV gaps in 13 patients, matching the typical lesion distribution. Gaps were undetected by the pentaspline PFA catheter. During follow-up, LA roof-dependent tachycardia was the most common recurrent arrhythmia (n = 11, 5.4%). ML model demonstrated size of the electrically intact tissue-bridge within the LA roof after PFA combined with LA size as predictors of occurrence of this specific tachycardia (AUC, 0.86; Sens., 0.86; Spec., 0.82). Additionally, ML models identified LA size and persistent AF as key predictors of gap presence (AUC, 0.88; Sens., 0.90; Spec., 0.83).

conclusionML models build with UHDM and clinical data can identify patients at risk for LA roof-dependent atrial tachycardia during follow-up and ablation gaps. Ablation strategies adapted to this information may potentially improve long-term outcomes in AF management.

Indexed as

Atrial FibrillationBody Surface Potential MappingCatheter AblationPulmonary VeinsFemaleHumansMachine LearningMaleMiddle AgedPredictive Learning ModelsRecurrenceTreatment OutcomeAtrial fibrillationAtrial tachycardiaPulmonary vein isolationPulsed field ablationUltra-high-density mapping

Identifiers

PMID41609948

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.