ArticleHeart rhythm O22026
First multicenter Japanese registry on tissue proximity-guided pulsed field ablation: Procedural safety and mid-term outcomes.
Article in Heart rhythm O2, 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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Who cites it
1 citing paper in PubMed.
- Irrigation-dependent acute ganglionated plexus modulation during variable-loop pulsed field ablation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Observational
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Authors and funding
24 authors.
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Abstract
Background: Pulsed field ablation (PFA) is a novel therapy for atrial fibrillation (AF) with myocardial selectivity and safety. The VARIPULSE catheter (variable-loop circular catheter [VLCC]; Biosense Webster, Inc.) was recently introduced in Japan, but multicenter real-world data remain scarce. Objective: This study aimed to evaluate procedural features, acute safety, and early outcomes of tissue proximity indication (TPI)-guided PFA under structured training and standardized protocols. Methods: We retrospectively analyzed 387 consecutive patients with AF (66.4 ± 10.9 years, 69% male, 87.1% paroxysmal) undergoing initial pulmonary vein isolation (PVI) with the VLCC at 10 Japanese centers (April 2024-May 2025). TPI-guided first-pass PVI targeted ≥12 applications per vein in 4 sets (proximal/distal), with additional ablation at TPI-negative sites. Operators received training and followed a harmonized workflow emphasizing TPI guidance and sheath management. Results: First-pass PVI was achieved in 360 patients (93.0%). After limited touch-up (6.9 ± 3.6 applications), complete PVI was obtained in all. Mean PVI time was 32.1 minutes, procedure duration 89.7 minutes, and median fluoroscopy time 3.0 minutes. Three patients (0.8%) had vascular complications; no tamponade, stroke, transient ischemic attack, or renal injury occurred. Predictors of first-pass failure were higher body mass index and lack of pre-mapping, mainly in early cases, declining from 11.4% to 3.0% ( Conclusion: In this first multicenter real-world study, TPI-guided PFA with the VLCC demonstrated high acute efficacy, no clinical strokes or TIAs, low complication rates, and favorable mid-term outcomes with structured training and standardized protocols.
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