A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates

Florent Farnir; Sevasti-Maria Chaldoupi; Ben Jm Hermans; Frédéric Farnir; Zarina Habibi; Kezia Jerltorp; Dominique Verhaert; Ulrich Schotten; Bart Maesen; Kevin Vernooy; Justin Luermans; Dominik Linz

doi:10.1016/j.hrthm.2025.01.015

A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates

Florent Farnir
, Sevasti-Maria Chaldoupi
, Ben Jm Hermans
, Frédéric Farnir
, Zarina Habibi
, Kezia Jerltorp
, Dominique Verhaert
, Ulrich Schotten
, Bart Maesen
, Kevin Vernooy
, Justin Luermans
, Dominik Linz^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF). Objective: We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate. Methods: Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force–sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated. Results: In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m ²; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl). Conclusion: Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.

Original language	English
Pages (from-to)	1957-1968
Number of pages	12
Journal	Heart Rhythm
Volume	22
Issue number	8
Early online date	17 Jan 2025
DOIs	https://doi.org/10.1016/j.hrthm.2025.01.015
Publication status	Published - Aug 2025

Keywords

Atrial Fibrillation
First Pass Isolation
Focal Ablation
Posterior Wall Isolation
Pulsed Field Ablation
Safety

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10.1016/j.hrthm.2025.01.015Licence: CC BY

Cite this

Farnir, F., Chaldoupi, S.-M., Hermans, B. J., Farnir, F., Habibi, Z., Jerltorp, K., Verhaert, D., Schotten, U., Maesen, B., Vernooy, K., Luermans, J., & Linz, D. (2025). A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates. Heart Rhythm, 22(8), 1957-1968. https://doi.org/10.1016/j.hrthm.2025.01.015

@article{a64770086a8444cc8f697196708abc42,

title = "A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates",

abstract = "Background: Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF). Objective: We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate. Methods: Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force{\textendash}sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated. Results: In 83 patients (33\% female; indexed left atrial volume, 44 ± 15 mL/m 2; 80\% persistent AF or atrial flutter [AFl]; 57\% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl). Conclusion: Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100\% with 64\% freedom from arrhythmias after 6 months.",

keywords = "Atrial Fibrillation, First Pass Isolation, Focal Ablation, Posterior Wall Isolation, Pulsed Field Ablation, Safety",

author = "Florent Farnir and Sevasti-Maria Chaldoupi and Hermans, \{Ben Jm\} and Fr{\'e}d{\'e}ric Farnir and Zarina Habibi and Kezia Jerltorp and Dominique Verhaert and Ulrich Schotten and Bart Maesen and Kevin Vernooy and Justin Luermans and Dominik Linz",

year = "2025",

month = aug,

doi = "10.1016/j.hrthm.2025.01.015",

language = "English",

volume = "22",

pages = "1957--1968",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier B.V.",

number = "8",

}

Farnir, F, Chaldoupi, S-M , Hermans, BJ, Farnir, F, Habibi, Z, Jerltorp, K, Verhaert, D , Schotten, U , Maesen, B , Vernooy, K , Luermans, J & Linz, D 2025, 'A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates', Heart Rhythm, vol. 22, no. 8, pp. 1957-1968. https://doi.org/10.1016/j.hrthm.2025.01.015

A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates. / Farnir, Florent; Chaldoupi, Sevasti-Maria ; Hermans, Ben Jm et al.
In: Heart Rhythm, Vol. 22, No. 8, 08.2025, p. 1957-1968.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate

T2 - Procedural data and 6-month success rates

AU - Farnir, Florent

AU - Chaldoupi, Sevasti-Maria

AU - Hermans, Ben Jm

AU - Farnir, Frédéric

AU - Habibi, Zarina

AU - Jerltorp, Kezia

AU - Verhaert, Dominique

AU - Schotten, Ulrich

AU - Maesen, Bart

AU - Vernooy, Kevin

AU - Luermans, Justin

AU - Linz, Dominik

PY - 2025/8

Y1 - 2025/8

N2 - Background: Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF). Objective: We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate. Methods: Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force–sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated. Results: In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m 2; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl). Conclusion: Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.

AB - Background: Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF). Objective: We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate. Methods: Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force–sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated. Results: In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m 2; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl). Conclusion: Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.

KW - Atrial Fibrillation

KW - First Pass Isolation

KW - Focal Ablation

KW - Posterior Wall Isolation

KW - Pulsed Field Ablation

KW - Safety

U2 - 10.1016/j.hrthm.2025.01.015

DO - 10.1016/j.hrthm.2025.01.015

M3 - Article

SN - 1547-5271

VL - 22

SP - 1957

EP - 1968

JO - Heart Rhythm

JF - Heart Rhythm

IS - 8

ER -

A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates

Abstract

Keywords

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