{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:50:10Z","timestamp":1791949810242,"version":"4.3.4"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulsed field ablation (PFA) has emerged as a promising energy source for atrial fibrillation (AF) catheter ablation. This study aimed to describe the adoption and workflow optimization of a novel balloon\u2010in\u2010basket PFA catheter using a two rings balloon and pear strategy for pulmonary vein isolation (PVI), the pear workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive all\u2010comer patients with AF underwent PFA using the balloon\u2010in\u2010basket PFA catheter under deep sedation. The pear workflow comprised a two\u2010step PVI protocol: (1) four antral PFA applications guided by initial PV angiography to confirm PV occlusion and lesion overlap through rotational deployment, followed by (2) two distal, pear\u2010shaped balloon applications targeting the PV sleeves. Three\u2010dimensional electroanatomic mapping with impedance\u2010based contact assessment was utilized. Procedural parameters, acute efficacy, and safety were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty patients (62% paroxysmal AF, 42% female, mean age 68\u2009\u00b1\u200910 years) were enrolled. All PVs were successfully isolated. Median procedural and fluoroscopy times were 50\u2009min (IQR 41\u201350) and 7.2\u2009min (IQR 5.8\u201311.4), respectively, without significant change over the study course (50 vs. 47\u2009min for patients 1\u221225 and 26\u221250, respectively,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.26). Additional ablation was performed in four patients, and concomitant left atrial appendage closure was performed in three. No major or minor complications occurred. Transient phrenic nerve stunning was observed in two patients, resolving before procedure completion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The pear two\u2010step strategy enables rapid, efficient, and safe PVI using a balloon\u2010in\u2010basket PFA catheter, which, despite its anatomically based design, offers procedural versatility through integrated mapping with a minimal learning curve.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70489","type":"journal-article","created":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T18:34:36Z","timestamp":1788719676000},"page":"2298-2307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Pear Strategy for Two\u2010Ring Pulmonary Vein Isolation: Antral and Sleeve Ablation Using a Balloon\u2010in\u2010Basket Pulsed Field Ablation Catheter"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7561-7185","authenticated-orcid":false,"given":"Melanie A.","family":"Gunawardene","sequence":"first","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"},{"name":"Centre for Heart Rhythm Disorders University of Adelaide and Royal Adelaide Hospital Adelaide South Australia Australia"},{"name":"Department of Cardiology University Hospital Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8905-0922","authenticated-orcid":false,"given":"Andrea","family":"Urbani","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5234-744X","authenticated-orcid":false,"given":"Lukas","family":"Urbanek","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Alexandra","family":"Marx","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1538-406X","authenticated-orcid":false,"given":"Joseph","family":"Kheir","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3099-8196","authenticated-orcid":false,"given":"Julia","family":"Lurz","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"},{"name":"Department of Cardiology Johannes Gutenberg University Hospital Mainz Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8844-4042","authenticated-orcid":false,"given":"Matteo","family":"Rocchetti","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4188-3447","authenticated-orcid":false,"given":"David","family":"Schaack","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2355-6015","authenticated-orcid":false,"given":"K. 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Julian","family":"Chun","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"},{"name":"Department of Rhythmology University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein L\u00fcbeck Germany"},{"name":"Medizinische Klinik III Agaplesion Markuskrankenhaus Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5347-9906","authenticated-orcid":false,"given":"Boris","family":"Schmidt","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital Frankfurt am Main Germany"},{"name":"Medizinische Klinik III Agaplesion Markuskrankenhaus Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn570"},{"issue":"1","key":"e_1_2_11_4_1","first-page":"43","article-title":"Influence of Energy Source on Early Atrial Fibrillation Recurrences: A Comparison of Cryoballoon vs. Radiofrequency Current Energy Ablation With the Endpoint of Unexcitability in Pulmonary Vein Isolation","volume":"20","author":"Gunawardene M. 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