{"doi":"10.1093/europace/euae072","title":"Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Aims</jats:title>\n                  <jats:p>Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results</jats:title>\n                  <jats:p>Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021–02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.</jats:p>\n                  <jats:p>A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P &amp;lt; 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11–7.65), P = 0.0473].</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion</jats:title>\n                  <jats:p>Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.</jats:p>\n               </jats:sec>","journal":"Europace","year":2024,"id":594784,"datarank":0.42498200160843247,"base_score":2.833213344056216,"endowment":2.833213344056216,"self_citation_contribution":0.42498200160843247,"citation_network_contribution":0.0,"self_endowment_contribution":0.42498200160843247,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1522758,"name":"Tim Harloff","orcid":"0009-0000-1506-5366","position":1,"is_corresponding":false},{"id":1522759,"name":"Mario Jularic","orcid":null,"position":2,"is_corresponding":false},{"id":881894,"name":"Jannis Dickow","orcid":"0000-0002-0374-4983","position":3,"is_corresponding":false},{"id":1522760,"name":"Rahin Wahedi","orcid":"0009-0001-3596-4382","position":4,"is_corresponding":false},{"id":1522761,"name":"Omar Anwar","orcid":"0000-0001-9738-4685","position":5,"is_corresponding":false},{"id":1522762,"name":"Peter Wohlmuth","orcid":"0000-0002-1636-7865","position":6,"is_corresponding":false},{"id":1522763,"name":"Nele Gessler","orcid":"0000-0001-5626-7749","position":7,"is_corresponding":false},{"id":1522764,"name":"Jens Hartmann","orcid":null,"position":8,"is_corresponding":false},{"id":1522765,"name":"Stephan Willems","orcid":"0000-0002-8890-5749","position":9,"is_corresponding":false},{"id":1522757,"name":"Melanie A Gunawardene","orcid":"0000-0001-7561-7185","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Aims</jats:title>\n                  <jats:p>Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results</jats:title>\n                  <jats:p>Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021–02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.</jats:p>\n                  <jats:p>A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P &amp;lt; 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11–7.65), P = 0.0473].</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion</jats:title>\n                  <jats:p>Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.</jats:p>\n               </jats:sec>","is_dataset_classified":null,"base_score":2.772588722239781,"endowment":2.772588722239781,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"38513110","pmcid":"PMC11034699","openalex_id":"https://openalex.org/W4393032584","authors":[],"funders":[],"total_grants":0,"fwci":4.5678,"citation_percentile":0.95603108,"influential_citations":0,"citation_trend":[{"year":2024,"count":1},{"year":2025,"count":11},{"year":2026,"count":3}],"oa_status":"hybrid","license":"cc-by-nc","oa_locations":[{"url":"https://academic.oup.com/europace/advance-article-pdf/doi/10.1093/europace/euae072/57051132/euae072.pdf","host_type":"journal"},{"url":"https://academic.oup.com/europace/advance-article-pdf/doi/10.1093/europace/euae072/57051132/euae072.pdf","host_type":"publisher"},{"url":"https://academic.oup.com/europace/article-pdf/26/4/euae072/57346300/euae072.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1093/europace/euae072","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/38513110","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11034699","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11034699","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC11034699?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Cardiac Arrhythmias and Treatments","Atrial Fibrillation Management and Outcomes","Cardiac pacing and defibrillation studies","Humans","Catheter Ablation","Male","Female","Aged","Atrial Fibrillation","Tachycardia, Supraventricular","Prospective Studies","Middle Aged","Treatment Outcome","Electrophysiologic Techniques, Cardiac","Action Potentials","Time Factors","Recurrence"],"mesh_terms":["Action Potentials","Aged","Atrial Fibrillation","Female","Humans","Male","Middle Aged","Prospective Studies","Recurrence","Tachycardia, Supraventricular","Time Factors","Treatment Outcome","Catheter Ablation","Electrophysiologic Techniques, Cardiac"],"keywords":["Ablation","Atrial fibrillation","Catheter ablation","Cardiology","Medicine","Internal medicine","Atrial tachycardia","Current (fluid)","Electrical engineering","Engineering","High-density Mapping","Pulsed Field Ablation","Left Posterior Wall Isolation"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Affordable and clean energy"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-27T15:33:20.277326Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}