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June 27, 2026EP EuropaceOpen Access

Focal-bipolar PFA achieves 100% acute success for para-Hisian accessory pathways without AV node damage.

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Why the study?

Does focal-bipolar pulsed field ablation safely eliminate accessory pathway conduction in patients with APs located near the bundle of His?

Population

6 patients undergoing first-time ablation of an accessory pathway located near the bundle of His.

Design

Case_series

Follow-up

2 ± 1 months

Key result

Focal-bipolar pulsed field ablation achieved acute procedural success in all 6 patients with accessory pathways near the bundle of His, with no procedure-related complications or AV node damage.

Authors

LZL ZarebskiPFP Futyma

Discussion

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Overview

Feasibility shown in small series; leaves open durability, safety, and generalizability for larger prospective evaluation.

Key Points

  • To evaluate the safety and feasibility of focal-bipolar pulsed field ablation for accessory pathways near the bundle of His.
  • Consecutive patients underwent first-time ablation of accessory pathways near the bundle of His.
  • A series of focal-bipolar pulsed field ablation applications were delivered at the site of accessory pathway location.
  • Procedural success defined as complete elimination of accessory pathway conduction.
  • Acute success achieved in all patients with no procedure-related complications, including AV node damage.
  • Mean procedure time was 58±23 minutes with 11±3 PFA applications and voltage between 1400 and 2000 V.
  • During a follow-up of 2±1 months, five patients maintained normal AV conduction, while one had recurrence of preexcitation.

Study Design

Type

Observational (n=6)

Structured PICO

Does focal-bipolar pulsed field ablation safely eliminate accessory pathway conduction in patients with APs located near the bundle of His?

P
Population
6 patients (mean age 32 years, 50% female) undergoing first-time ablation of an accessory pathway located near the bundle of His, followed for a mean of 2 months.
E
Exposure
Focal-bipolar pulsed field ablation (PFA) (voltage 1400-2000 V, mean 11±3 applications).
O
Outcome
Procedural success (defined as complete elimination of AP conduction) and safety (detection of any AV nodal function abnormalities).safety

Focal-bipolar pulsed field ablation appears feasible and safe for treating accessory pathways near the bundle of His without causing AV block.

Cite This Study

Zarebski et al. (2026) conducted an observational in Accessory pathways located near the bundle of His (n=6). Focal-bipolar pulsed field ablation was evaluated on Complete elimination of AP conduction (procedural success). Focal-bipolar pulsed field ablation achieved acute procedural success in all 6 patients with accessory pathways near the bundle of His, with no procedure-related complications or AV node damage.

synapsesocial.com/papers/6a3f97ce125782b61d8659aehttps://doi.org/10.1093/europace/euag105.962
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Also Consider

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

  1. 1Initial UK Experience of Focal Pulsed Field Ablation2025
  2. 2Pulsed-field Ablation for Paroxysmal and Persistent Atrial Fibrillation: A Single-center Experience2025
  3. 3Pulsed-field ablation using a circular multielectrode catheter for persistent atrial fibrillation: procedural outcomes and lesion durability2026
  4. 4Anatomical ablation using a dual-energy contact force-sensing focal ablation catheter vs standard radiofrequency ablation catheter for persistent atrial fibrillation: a comparative prospective study2026
  5. 5Acute efficacy of pulsed-field ablation of the mitral isthmus using a pentaspline catheter and two different ablation settings2026