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September 5, 2026EP EuropaceOpen Access

Balloon-in-basket PFA achieves ~92% durable PVI, with comparable results between EAM and fluoroscopy-only guidance.

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Why the study?

Does fluoroscopy plus electroanatomic mapping improve pulmonary vein isolation durability compared to fluoroscopy alone in patients with atrial fibrillation undergoing pulsed-field ablation?

Population

96 consecutive patients with paroxysmal or persistent atrial fibrillation undergoing de novo pulmonary vein…

Comparison

Fluoroscopy plus electroanatomic mapping… vs Fluoroscopy-only workflow for pulmonary vein…

Design

RCT, 1:1

Follow-up

median 41 days

Key result

Pulmonary vein isolation using a balloon-in-basket pulsed-field ablation catheter achieved 91.9% per-patient durability, with comparable results between fluoroscopy-only and EAM guidance.

Authors

DMDaniel MuñozILIsabel López-AlacidLGLucía Cobarro Gálvez

Discussion

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Overview

Supports fluoroscopy-only pulsed-field ablation for durable PVI; confirms no added benefit from electroanatomic mapping in this RCT.

Key Points

  • To evaluate chronic pulmonary vein isolation durability using a balloon-in-basket pulsed-field ablation catheter and compare fluoroscopy-only versus electroanatomic mapping workflows.
  • In a prospective, single-center randomized trial, 96 patients with paroxysmal or persistent atrial fibrillation underwent de novo pulmonary vein isolation (PVI).
  • Participants were randomized 1:1 to either a fluoroscopy-only workflow or a fluoroscopy plus electroanatomic mapping (EAM) workflow.
  • Invasive remapping was systematically conducted >30 days post-procedure (median 41 days) to assess vein isolation durability and safety events.
  • Systematic remapping in 86 patients demonstrated overall per-vein durability of 97.4% (341/350) and per-patient complete durability of 91.9% (79/86).
  • Median fluoroscopy time was 3.4 minutes [IQR 2.4–4.6] across 15 [IQR 13–16] applications, with durability and remapping parameters remaining comparable between fluoroscopy-only and EAM guidance.
  • Zero major adverse events occurred within 30 days of the index or remapping procedures.

Study Design

Type

RCT (n=96)

Randomization

1:1

Multicenter

No

Structured PICO

Does fluoroscopy plus electroanatomic mapping improve pulmonary vein isolation durability compared to fluoroscopy alone in patients with atrial fibrillation undergoing pulsed-field ablation?

P
Population
96 patients with paroxysmal or persistent atrial fibrillation undergoing de novo PVI with a balloon-in-basket PFA catheter, followed for a median of 41 days.
I
Intervention
Fluoroscopy plus electroanatomic mapping (EAM) workflow for pulmonary vein isolation with a balloon-in-basket pulsed-field ablation catheter
C
Comparator
Fluoroscopy-only workflow for pulmonary vein isolation with a balloon-in-basket pulsed-field ablation catheter
O
Outcome
Dual primary efficacy endpoint: proportion of pulmonary veins (PVs) and of patients with all PVs durably isolated assessed by systematic invasive remapping >30 days after index proceduresurrogate

Balloon-in-basket pulsed-field ablation achieves high pulmonary vein isolation durability, and adding electroanatomic mapping to fluoroscopy does not improve procedural or durability outcomes compared to fluoroscopy alone.

Cite This Study

Muñoz et al. (2026) conducted an RCT in paroxysmal or persistent atrial fibrillation (n=96). Fluoroscopy plus electroanatomic mapping (EAM) workflow vs. Fluoroscopy-only workflow was evaluated on proportion of pulmonary veins (PVs) and of patients with all PVs durably isolated. Pulmonary vein isolation using a balloon-in-basket pulsed-field ablation catheter achieved 91.9% per-patient durability, with comparable results between fluoroscopy-only and EAM guidance.

synapsesocial.com/papers/6a9bd4726b95aff0620ec326https://doi.org/10.1093/europace/euag244
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Also Consider

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

  1. 1Novel mapping-integrated pulsed-field ablation technology for pulmonary vein isolation in patients with atrial fibrillation: learning curve, efficiency, and safety2026
  2. 2Beyond the Learning Curve: How Operator Experience Affects Pulsed-Field Ablation Outcomes2025 · 10 citations
  3. 3Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation – insights from acute and chronic electroanatomic remapping in the randomized SINGLE-SHOT CHAMPION trial2026
  4. 4Safety, efficacy and reproducibility of a simplified strategy to achieve pulmonary vein isolation using radiofrequency ablation2026
  5. 5Comparison of Pentaspline Pulsed Field Ablation Catheter Mapping Modes to Assess Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation2026