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June 27, 2026EP EuropaceOpen Access

PFA yields ~60% fewer complete PV-encircling LGE-lesions than cryoballoon ablation despite similar arrhythmia-free survival.

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Why the study?

Does pentaspline pulsed field ablation improve complete PV-encircling LGE-lesions at 3 months compared to cryoballoon ablation in patients with paroxysmal or persistent atrial fibrillation?

Population

106 patients with paroxysmal or persistent atrial fibrillation. Excluded: long-standing persistent AF, LVEF…

Comparison

Pulmonary vein isolation using pentaspline… vs Pulmonary vein isolation using cryoballoon…

Design

RCT, 2:1 fashion

Follow-up

6 months

Key result

Pulsed-field ablation resulted in a lower rate of complete PV-encircling LGE-lesions at 3 months compared to cryoballoon ablation (17% vs 43%, p<0.01), despite similar arrhythmia-free survival.

Authors

CGC GranataRPR PittorruACA Comellas

Discussion

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Overview

PFA yields fewer durable PV lesions than cryoballoon; challenges equivalence assumptions and extends RCT data on single-shot ablation durability.

Key Points

  • The trial aims to compare lesion durability of pentaspline pulsed-field ablation with cryoballoon ablation based on MRI assessment.
  • Randomized trial involving 106 patients with atrial fibrillation assigned 2:1 to PFA or cryoballoon ablation.
  • Exclusion criteria included long-standing persistent AF and significant comorbidities.
  • Post-ablation LGE-MRI performed at three months to assess lesion quality.
  • Complete PV-encircling LGE-lesions occurred in 17% of PFA vs. 43% of cryoballoon (p<0.01).
  • Average number of gaps: 3.1 in PFA group vs. 2.1 in cryoballoon group (p<0.05).
  • Atrial fibrillation free survival after six months was similar (PFA: 88.9%; Cryo: 85.7%; p=0.76).

Study Design

Type

RCT (n=106)

Randomization

2:1

Structured PICO

Does pentaspline pulsed field ablation improve complete PV-encircling LGE-lesions at 3 months compared to cryoballoon ablation in patients with paroxysmal or persistent atrial fibrillation?

P
Population
106 patients (mean age 64, 78% paroxysmal) with paroxysmal or persistent atrial fibrillation, evaluated in a prespecified interim analysis of 53 patients followed for 6 months.
I
Intervention
Pulmonary vein isolation (PVI) using pentaspline pulsed-field ablation (PFA) single-shot device
C
Comparator
Pulmonary vein isolation (PVI) using cryoballoon ablation
O
Outcome
Complete PV-encircling LGE-lesions at 3 months assessed by post-ablation LGE-MRIsurrogate

Main Result

Absolute Event Rate: 17% vs 43%

p-value: p=<0.01

In patients with AF, pentaspline pulsed-field ablation resulted in fewer complete PV-encircling LGE-lesions at 3 months compared to cryoballoon ablation, though 6-month arrhythmia-free survival was similar.

Limitations

  • Heterogeneous LGE patterns with PFA may reflect a different, less detectable kind of remodeling compared to thermal ablation rather than true minor lesion durability.
  • Interim analysis of only 53 patients
  • Heterogeneous LGE patterns with PFA may reflect a different, less detectable kind of remodeling compared to thermal ablation rather than true lack of durability

Cite This Study

Granata et al. (2026) conducted an RCT in Paroxysmal or persistent atrial fibrillation (AF) (n=106). Pulsed-field ablation (PFA) vs. Cryoballoon ablation was evaluated on Complete PV-encircling LGE-lesions at 3 months (p=<0.01). Pulsed-field ablation resulted in a lower rate of complete PV-encircling LGE-lesions at 3 months compared to cryoballoon ablation (17% vs 43%, p<0.01), despite similar arrhythmia-free survival.

synapsesocial.com/papers/6a3f9785125782b61d8657b3https://doi.org/10.1093/europace/euag105.451
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Pulsed field or cryoballoon ablation for paroxysmal atrial fibrillation—insights from acute and chronic electroanatomic remapping in the randomized SINGLE-SHOT CHAMPION trial2026
  2. 2Pulsed field ablation versus cryoballoon ablation for pulmonary vein isolation in atrial fibrillation: a systematic review and meta-analysis with subgroup analyses by AF type2026
  3. 3Short term biatrial remodeling after pulsed field ablation vs cryoablation: a comparative cardiac magnetic resonance volumetric and strain analysis2026
  4. 4Impact of pulsed field versus cryoballoon ablation on left atrial function and stiffness in paroxysmal atrial fibrillation2026
  5. 5Pulsed field vs cryoballoon ablation: A meta-analysis with Hartung–Knapp, subgroup, and meta-regression analyses2025