Extent of posterior wall lesion following pulmonary vein isolation with pentaspline pulsed field and cryoballoon ablation: the potential role of deployment technique.

Background: Pulmonary vein isolation (PVI) using cryoballoon (CB) or pulsed field ablation (PFA) with a pentaspline catheter achieves similar efficacy in atrial fibrillation (AF), but lesion extension on the left atrial posterior wall (LAPW) may differ. Pentaspline-PFA (P-PFA) has been reported to create broader LAPW lesions, potentially leaving narrow viable corridors that have been hypothesized to be proarrhythmic. Objective: To descriptively compare the extent of chronic unintended left atrial posterior wall isolation after PVI with P-PFA and CB ablation. Methods: We conducted a single-center ambispective study including consecutive patients undergoing repeat left atrial mapping after index PVI with either P-PFA, using a protocol designed to ensure catheter alignment with the pulmonary veins, or CB. Patients with additional LA ablation between index procedure and remapping, unrelated LAPW scarring, or posterior pulmonary vein gaps were excluded. The primary endpoint was isolated LAPW area. Secondary endpoints included percentage of isolated LAPW and minimum residual corridor width. Results: Seventy-four patients were included in the analysis: 49 P-PFA and 25 CB. Mean age was 64.2 ± 10.0 years, 64.9% were male, and 55.4% had persistent AF. Isolated LAPW area was 8.3 ± 4.0 cm Conclusion: In this descriptive, hypothesis-generating study, no statistically significant difference in chronic LAPW isolation extent was detected between P-PFA and CB ablation. These findings support the hypothesis that catheter deployment technique may influence posterior wall lesion geometry, warranting confirmation in adequately powered prospective studies.