Acute left atrial pressure changes after pulsed field ablation for atrial fibrillation: comparison of pentaspline and fixed-loop multielectrode catheters
Y Matsunaga, Y Egami, N Kobayashi, A Sugino, M Abe, H Nohara, S Kawanami, K Yasumoto, N Okamoto, M Yano, M NishinoAbstract
Background
Pulsed field ablation (PFA) has been rapidly adopted for catheter ablation of atrial fibrillation (AF) because of its favorable safety profile, particularly with respect to extracardiac injury. However, achieving durable lesions may still affect the surrounding atrial myocardium and could contribute to increases in left atrial (LA) pressure and worsening heart failure. Because PFA devices differ in catheter design and energy delivery protocols, their myocardial effects may vary across devices. This study aimed to evaluate the impact of different PFA devices on LA pressure.
Methods
LA pressure was measured directly through a sheath positioned in the LA before and after PFA application. Between November 2025 and February 2026, 58 consecutive patients who underwent successful LA pressure measurements both before and after PFA were enrolled. PFA procedure and LA pressure measurement were performed under general anesthesia in all patients. A pentaspline catheter was used in 38 patients (66%), and a fixed-loop multielectrode catheter was used in 20 patients (34%). Elevated LA pressure with a prominent v-wave was defined as a v-wave ≥25 mmHg or a v-wave–to–mean LA pressure difference ≥10 mmHg.
Results
LA pressure after PFA was significantly higher than before PFA for the a-wave (12.9 ± 4.2 vs. 14.7 ± 4.2 mmHg, p < 0.01), v-wave (12.8 ± 5.5 vs. 16.0 ± 7.7 mmHg, p < 0.01), and mean LA pressure (9.9 ± 3.9 vs. 11.5 ± 4.3 mmHg, p < 0.01).
The prevalence of elevated LA pressure with a prominent v-wave increased from 5.2% before PFA to 10.3% after PFA, although this change did not reach statistical significance (p = 0.37). Changes in LA a-wave, v-wave, and mean pressure did not differ between devices (all p > 0.3). The prevalence of post-PFA elevated LA pressure with a prominent v-wave was comparable between the pentaspline and fixed-loop multielectrode catheters (10.5% vs. 10.0%; p = 1.00; OR 0.95, 95% CI 0.08–7.35).
Conclusions
PFA application significantly increased LA pressure. However, no difference between devices was observed, suggesting that elevated LA pressure with a prominent v-wave may be attributable to the PFA procedure itself or underlying patient characteristics, rather than device-specific effects.Figure