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June 27, 2026EP EuropaceOpen Access

Acute PVI was achieved in 100% of patients, with significant improvements in skin-to-skin time (75 vs. 60 min, p=0.001) and fluoroscopy time (16 vs. 11 min, p=0.009) observed after the first 5 cases per operator.

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Why the study?

Does mapping-integrated pulsed-field ablation (PFA) demonstrate high procedural efficiency, safety, and a short learning curve in patients undergoing first-time pulmonary vein isolation for atrial fibrillation?

Population

244 consecutive patients undergoing their first pulmonary vein isolation procedure for atrial fibrillation…

Comparison

Pentaspline pulsed-field ablation integrated… vs For the learning curve analysis, early operator…

Design

Cohort

Authors

GMG MitacchioneMSM SchiavoneEAE Agus

Discussion

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Overview

Supports PFA procedural feasibility in real-world use; leaves open durability, safety, and comparative efficacy.

Key Points

  • The aim is to evaluate the learning curve and procedural efficiency of a novel mapping-integrated pulsed-field ablation system for pulmonary vein isolation in atrial fibrillation.
  • Multicenter observational study across 18 centers with consecutive patients undergoing their first pulmonary vein isolation procedure.
  • Operators predefined their ablation strategy and documented deviations during the procedure.
  • Procedural metrics analyzed in relation to operator experience.
  • Acute pulmonary vein isolation achieved in 100% of patients with a median of 44 PFA applications.
  • Significant efficiency improvements observed after five cases: Cath lab utilization decreased from 110 min to 95 min (p=0.011).
  • No major complications were reported, indicating high safety.

Structured PICO

Does mapping-integrated pulsed-field ablation (PFA) demonstrate high procedural efficiency, safety, and a short learning curve in patients undergoing first-time pulmonary vein isolation for atrial fibrillation?

P
Population
244 consecutive patients undergoing their first pulmonary vein isolation (PVI) procedure for atrial fibrillation (88.1% paroxysmal AF) across 18 centers. Cases involving additional ablation targets were excluded.
I
Intervention
Pentaspline pulsed-field ablation (PFA) integrated with a novel mapping system (Faraview) for pulmonary vein isolation.
C
Comparator
For the learning curve analysis, early operator experience (first 5 cases) was compared to later operator experience (after the first 5 cases).
O
Outcome
Procedural efficiency (total cath lab utilization, skin-to-skin time, and fluoroscopy time), acute procedural outcomes (acute PVI success), and operator learning curve.

Mapping-integrated pulsed-field ablation for pulmonary vein isolation is highly effective and safe acutely, featuring a steep learning curve that plateaus in procedural efficiency after just five cases.

Cite This Study

Mitacchione et al. (2026) studied this question.

synapsesocial.com/papers/6a3f9785125782b61d8657e4https://doi.org/10.1093/europace/euag105.500
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