31 vs. 35 mm: pulsed-field ablation with two different-sized pentaspline catheters for the treatment of atrial fibrillation

Pulsed-field ablation (PFA) using a pentaspline catheter has emerged as an effective and safe strategy for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The pentaspline catheter system is available in two different sizes: 31 mm and 35 mm. Data comparing these two sizes regarding procedural efficiency and clinical outcomes remain limited.

To compare procedural metrics and clinical outcomes of patients undergoing PVI for the treatment of AF using a 31 mm versus a 35 mm pentaspline catheter system.

Patients with AF undergoing PVI with either a 31 mm or a 35 mm pentaspline PFA catheter at a tertiary referral center were consecutively included in a prospective registry between January 2022 and November 2024. Patients were propensity score matched based on age, sex, AF type and cardiovascular risk factors.

360 patients (median age 68 [62 – 74] years, 29% female) were included. Of these, 53% had paroxysmal AF and 47% had persistent AF. 240 patients (67%) underwent PFA using a 31mm and 120 patients (33%) using a 35mm PFA catheter. The total procedure duration was 54 [40 - 70] min in the 31 mm group vs. 48 [36 - 64] min in the 35 mm group (p = 0.033). Left atrial dwell time and fluoroscopy time were similar between the 31 mm and 35 mm group: 36 [24 - 50] min vs. 33 [23 - 47] min (p = 0.347) and 10 [7 - 14] min vs. 10 [7 - 14] min (p = 0.960), respectively. In the 31 mm and 35 mm groups, 77% and 78% underwent first PVI, while 23% and 22% had a redo-PVI. Additional lesions were performed in 111 patients (46%) in the 31 mm group and 49 (41%) in the 35 mm group, with 79% and 78% undergoing posterior wall isolation. Total PFA applications were 37 [32–50] in the 31 mm group and 36 [34–50] in the 35 mm group (p = 0.899). During a median follow-up of 225 days, recurrence-free survival was 76% in the 31 mm group group and 78% in the 35 mm group (pLog-rank = 0.510).

Both the 31 mm and 35 mm pentaspline PFA catheters demonstrated comparable procedural metrics and clinical outcomes in patients undergoing PVI.Figure