Comparative 1-year outcomes of pentaspline versus circular array pulsed field ablation for pulmonary vein isolation with adjunctive atrial lines

BACKGROUND: Pulsed field ablation (PFA) has emerged as an effective and safe single-shot technology for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, comparative long-term outcome data between different PFA catheter designs, particularly for additional atrial ablation beyond PVI, remain scarce. OBJECTIVE: This study aimed to compare 1-year clinical outcomes and procedural performance of pentaspline versus circular PFA catheters for PVI with additional left atrial roof line ablation (LARA). METHODS: ). The primary end point was freedom from atrial arrhythmia after a 3-month blanking period. RESULTS: A total of 200 patients were included (65% male, 44% persistent AF, median age 66 [interquartile range {IQR} 59-74] years), with 100 patients per group and no baseline differences. LARA was performed in 30% (30/100) of pentaspline and 32% (32/100) of circular PFA procedures, respectively. Acute PVI and bidirectional block of all additional lines were achieved in 100% of cases. Median procedure time (63 [IQR 54-77] vs 67 [IQR 59-80] min; P = .06) and fluoroscopy time (11.9 [9.8-15.2] vs 13.2 [10.2-15.9] min; P = .203) were comparable. Overall complication rates were low and similar (5% vs 3%). During a median follow-up of 386 (IQR 349-486) days, 1-year arrhythmia-free survival was similar between pentaspline and circular PFA catheters (81.7% vs 81.8%; log-rank P = .90), with comparable outcomes in paroxysmal and persistent AF. CONCLUSION: Pentaspline and circular PFA catheters demonstrate comparable safety, procedural performance, and 1-year clinical efficacy for PVI and LARA. These findings support the feasibility of comprehensive PFA-based atrial ablation strategies in patients with persistent atrial fibrillation and enlarged left atria.