{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:48:28Z","timestamp":1791614908782,"version":"4.3.4"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"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"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pentaspline pulsed\u2010field ablation (PFA) has emerged as a novel modality for pulmonary vein isolation (PVI) and posterior wall isolation (PWI) in persistent atrial fibrillation (AF). However, the learning curve associated with combined PVI\u2009+\u2009PWI and the contribution of anatomical factors to acute lesion completeness remain incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 182 consecutive patients with persistent AF undergoing fluoroscopy\u2010 and intracardiac echocardiography\u2013guided PFA. Acute incomplete lesions were defined as residual conduction requiring additional PFA applications after systematic remapping. Learning phases were identified using segmented logistic regression and sequential block analysis. Multivariable models evaluated procedural phase, left atrial volume (LAV), and posterior wall geometry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A learning curve was observed, with the greatest reduction in incomplete lesion formation occurring during the first 20 procedures. Incomplete lesions occurred in 55% of cases 1\u201320 (early phase), 32% of cases 21\u2013160 (intermediate phase), and 4.8% of cases \u2265\u2009161 (late phase). Procedural phase was the dominant determinant of incomplete lesions, with approximately 24\u2010fold and 9\u2010fold higher odds during the early and intermediate phases, respectively. Larger LAV showed a modest independent association (OR 1.009 per mL), whereas posterior wall geometry was not independently associated. Mid\u2010term arrhythmia recurrence did not differ across phases, although follow\u2010up duration was shorter in the late phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lesion completeness during pentaspline PFA with PVI\u2009+\u2009PWI improves progressively with increasing procedural experience. Although larger LAV may contribute modestly to incomplete lesion formation, procedural experience appears to play the predominant role. Systematic electroanatomical remapping remains important for identifying and correcting incomplete lesions even after substantial procedural experience has been accumulated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70515","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T17:55:58Z","timestamp":1790531758000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Learning Curve of Pentaspline Pulsed\u2010Field Ablation With Posterior Wall Isolation for Persistent Atrial Fibrillation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7774-7477","authenticated-orcid":false,"given":"Atsuhiko","family":"Yagishita","sequence":"first","affiliation":[{"name":"Department of Cardiology School of Medicine Isehara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7353-9231","authenticated-orcid":false,"given":"Kazuma","family":"Iimura","sequence":"additional","affiliation":[{"name":"Department of Cardiology School of Medicine Isehara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aika","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Cardiology School of Medicine Isehara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3128-6421","authenticated-orcid":false,"given":"Mari","family":"Amino","sequence":"additional","affiliation":[{"name":"Department of Cardiology School of Medicine Isehara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5686-4324","authenticated-orcid":false,"given":"Yuji","family":"Ikari","sequence":"additional","affiliation":[{"name":"Department of Cardiology School of Medicine Isehara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Yoshioka","sequence":"additional","affiliation":[{"name":"Department of Cardiology School of Medicine Isehara Kanagawa 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the Learning Curve: How Operator Experience Affects Pulsed\u2010Field Ablation Outcomes","volume":"1547","author":"Kueffer T.","year":"2025","journal-title":"Heart Rhythm: The Official Journal of the Heart Rhythm Society"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16583"}],"container-title":["Journal of Cardiovascular 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