Pulmonary vein isolation using a novel dual-energy (RF-PF) ablation catheter: procedural effectiveness and safety in a real-world cohort

Background

A new dual-energy, contact-force catheter enables switching between radiofrequency (RF) and pulsed-field ablation (PFA) within a single point-by-point workflow. This hybrid concept allows delivery of durable RF lesions at anterior, ridge, and carina regions, while applying PFA to posterior segments to maximise collateral safety. Real-world evidence on the acute performance and safety of this approach remains limited.

Methods

Consecutive patients undergoing first pulmonary vein isolation (PVI) for atrial fibrillation were included. Wide-antral encirclement was performed using a dual-energy, contact-force catheter and a multimodality generator capable of RF and PFA delivery. PFA was applied to posterior and inferior segments (index target 400) and RF to anterior, ridge, and carina segments (index target 550). First-pa isolation (FPI) and reconduction sites were systematically documented. Pre- and post-procedural blood samples assessed intravascular haemolysis. All patients underwent oesophageal endoscopy, and most underwent cerebral MRI. Clinical follow-up at 3 and 6 months included two 48-hour Holter ECGs and outpatient evaluation.

Results

Sixty-two patients (age 68.1 ± 9.3 years; 66% male; CHA2DS2-VASc 2.8 ± 1.4; paroxysmal AF 43%) were treated. Median procedure duration was 91.0 (79.0–114.2) minutes, with effective ablation time 21.0 (18.0–26.0) minutes.

PVI was achieved in all patients. FPI occurred in 52/62 (84%) patients and 112/124 (90%) pulmonary vein (PV) pairs. Reconduction occurred in 12/124 (10%) PV pairs: 8 right-sided and 4 left-sided, showing a right-sided predominance. The right posterior carina was involved in 6 of the 8 right-sided cases, identifying it as a recurring gap location.

No oesophageal injuries were detected. Silent cerebral lesions were identified in 6/46 (13%) of scanned patients. Severe intravascular haemolysis occurred in 29 (47%), but remained clinically silent; only one patient developed acute kidney injury. Three vascular complications were managed conservatively.

Short-term follow-up is ongoing and will be presented.

Conclusion

Dual-energy ablation demonstrates procedural feasibility with short procedure times, high first-pass isolation rates, and a favourable safety profile. Reconduction was infrequent but clustered at the right posterior carina, indicating an anatomical region requiring particular attention. The absence of oesophageal injury, silent cerebral lesion rates consistent with previous data, and clinically insignificant haemolysis support the safety of this hybrid RF–PF strategy for PVI.