PO-01-149 INCIDENCE RATE AND PREDICTORS OF POSTERIOR WALL RECONNECTION AFTER PULSED FIELD ABLATION USING THE PENTASPLINE ABLATION CATHETER

Sergio Conti; Pierre Ollitrault; Amato Santoro; Giuseppe A. Sgarito

doi:10.1016/j.hrthm.2026.03.1688

Background Durable pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. With pulsed field ablation (PFA), which selectively targets cardiac tissue, more extensive lesions—including posterior wall isolation (PWI)—are frequently utilized, particularly in cases of persistent AF. Although PFA has shown a favourable safety and efficiency profile, lesion durability remains a challenge. Objective This study evaluated the incidence rate and predictors of posterior wall (PW) reconnection in a large series of patients who previously underwent PWI with the pentaspline PFA catheter. Methods Data were analyzed from 162 consecutive patients with paroxysmal and persistent AF who underwent PVI plus PWI at 5 different Institutes between January 2023 and January 2025. All patients underwent index procedure with the pentaspline PFA catheter. Patients were followed to evaluate AF recurrence. Redo procedures were performed using a 3D-electronatomical mapping system and a multielectrode mapping catheter to evaluate PVs and PW reconnection. PW was divided in 7 regions (PW to left superior PVs, PW to left inferior PVs, roof of PW, center of PW, bottom of PW, PW to right superior PVs, PW to right inferior PVs). Clinical and procedural data were tested as predictors of PW reconnection. Results PW reconnection was found in 32.1% of patients at redo. PW reconnection within the PW was the most common (44%). There were no demographic, clinical, and procedural differences between patients who had PW reconnection and those who did not, except that patients with PW reconnection had more index procedure guided by fluoroscopy only (3, 2.7% vs 15, 28.8%, p< 0.001). At multivariate Cox regression analysis, fluoroscopic-only guidance (HR 16.5, 95% CI 3.3–82.3, p<0.001) was the only independent predictor of PW reconnection. Conclusion In this large series of patients, PW reconnection after PFA with the pentaspline ablation catheter is not uncommon. The most common region of PW reconnection was the central area. PFA with the pentaspline ablation catheter guided only by fluoroscopy was found to be a strong predictor of PW reconnection.

PO-01-149 INCIDENCE RATE AND PREDICTORS OF POSTERIOR WALL RECONNECTION AFTER PULSED FIELD ABLATION USING THE PENTASPLINE ABLATION CATHETER

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