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However, clinical comparisons of those novel concepts with conventional ablation approaches regarding ablation lesions are lacking. To systematically investigate lesion characteristics of novel ablation concepts, we performed a prospective head-to-head comparison using late gadolinium enhancement (LGE)-CMR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included patients undergoing first-time PVI-only atrial fibrillation ablation\u2014either by ablation index\u2013guided radiofrequency ablation (RF), cryoballoon ablation (CRYO), HPSD (90W, 4\u00a0s), or PFA (Farapulse). All patients received an LGE-CMR 3\u00a0months post-ablation to assess ablation lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Post-ablation LGE-CMRs from 138 patients were analyzed (43 RF, 40 CRYO, 25 PFA, 30 HPSD). PFA resulted in the least continuous LGE lesion with the lowest proportion of complete PV-encircling LGE lesions (PFA 12%, HPSD 40%, RF 26%, CRYO 24%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0069). Ablation with the CRYO and PFA single-shot devices resulted in the widest lesions. Of note, HPSD lesions were significantly wider than conventional RF lesions (PFA 12.7\u00a0mm, HPSD 10.9\u00a0mm, RF 8.7\u00a0mm; CRYO 13.3\u00a0mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lesion characteristics differed significantly among the four ablation techniques. HPSD ablation resulted in the most continuous LGE lesions. Of note, HPSD lesions were also wider than conventional RF lesions, thus corroborating the concept of a shallower HPSD lesion geometry from experimental studies. PFA lesions cover relatively large areas but are more inhomogeneous. Wether this indicates ineffective ablation or lower detectability of PFA lesions by LGE-CMR remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>Ablation lesion characteristics differ significantly between ablation techniques, with high-power short-duration RF ablation (HPSD) resulting in the most continuous late gadolinium enhancement lesions in MRI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10840-025-02086-9","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T11:49:18Z","timestamp":1750765758000},"page":"1149-1160","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Head-to-head comparison of pulsed-field ablation, high-power short-duration ablation, cryoballoon and conventional radiofrequency ablation by MRI-based ablation lesion assessment"],"prefix":"10.1007","volume":"69","author":[{"given":"Mariona","family":"Regany-Closa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Pomes-Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Invers-Rubio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Borras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berta","family":"Pellicer-Sendra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Prat-Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosario Jesus","family":"Perea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Igor","family":"Morr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Baptiste","family":"Guichard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Arbelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Maria","family":"Tolosana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Guasch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreu","family":"Porta-Sanchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Sitges","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Brugada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Roca-Luque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Llu\u00eds","family":"Mont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3289-2985","authenticated-orcid":false,"given":"Till F.","family":"Althoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"2086_CR1","first-page":"26","volume":"2024","author":"S Tzeis","year":"2024","unstructured":"Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, et al. 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Dr. Guichard has received consulting honoraria from Microport CRM; he has received lecturing honoraria from Microport CRM and Abbott and has received unrestricted grant support for a fellowship from Abbott. Dr. Arbelo has received speaker and consulting honoraria from Biosense Webster and Bayer. Dr. Tolosana has received lecturing and consulting honoraria from Abbott, Boston Scientific, and Medtronic. Drs. Porta-S\u00e1nchez and Roca-Luque have received speaker and consulting honoraria from Biosense Webster, Abbott, and Boston Scientific. Drs. Brugada and Mont are shareholders of Galgo Medical. Prof. Llu\u00eds Mont has received honoraria as a lecturer and consultant and has received research grants from Abbott Medical, Biosense Webster, Boston Scientific, and Medtronic. Dr. Mont is a shareholder of Corify Care. Dr. Till Althoff has received research grants for investigator-initiated trials from Biosense Webster and honoraria as a lecturer and consultant for Abbott Medical Devices and Corify Care. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}