{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:55:35Z","timestamp":1793134535187,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"unspecified","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,1,15]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent atrial fibrillation (AF) remains challenging to treat with catheter ablation. The left atrial posterior wall (PW) may represent an important non-pulmonary vein (PV) substrate; however, randomised trials have not demonstrated improved outcomes with adjunctive PW isolation (PWI), potentially reflecting technical limitations of thermal ablation rather than a lack of mechanistic relevance. Pulsed-field ablation (PFA) is a non-thermal ablation modality that selectively targets myocardial tissue and may enable safer and more consistent PWI. We compared real-world outcomes of PFA and radiofrequency ablation (RFA) for combined PV isolation and PWI in patients with persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>200 consecutive patients (100 PFA and 100 RFA) undergoing combined PVI and PWI were retrospectively followed for up to 12 months. Baseline characteristics were broadly similar; however, PFA patients had lower left ventricular ejection fraction (LVEF) (43.5% (35.5\u201355.5%) vs 47% (40\u201358), p=0.01) and higher CHA\u2082DS\u2082-VA risk score (3 (2\u20134) vs 2 (1\u20133), p=0.01). Primary outcomes were acute procedural success and freedom from recurrent atrial tachyarrhythmia (AT) at 6 and 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PFA achieved near-universal PWI compared with RFA (99% vs RFA: 65%, p&lt;0.005), with shorter procedure duration (106 vs 143.5\u2009min, p&lt;0.005), reduced left atrial dwell time (62 vs 98\u2009min, p&lt;0.005), and faster time to PVI and PWI (all p&lt;0.005). Major non-vascular complications were uncommon (1.5%) and similar between groups. At 12 months, freedom from recurrent AT was higher with PFA (70% vs RFA 54%, p=0.03), with lower odds of first detected AT recurrence in adjusted time-to-event analysis (OR 0.46 (0.26\u20130.82), p=0.009).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real-world cohort, PFA was associated with a higher rate of acute PWI and greater freedom from AT compared with RFA, without a signal of increased complications. Prospective randomised studies are needed to define the role of PWI delivered with PFA in patients with persistent AF, including those with reduced LVEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003798","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T14:55:52Z","timestamp":1770216952000},"page":"e003798","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical outcomes of pulsed field versus radiofrequency ablation, incorporating posterior wall isolation, in persistent atrial fibrillation"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4416-8986","authenticated-orcid":false,"given":"Omar","family":"Ahmed","sequence":"first","affiliation":[{"name":"City St George\u2019s University of London, London, UK"},{"name":"Royal Brompton & Harefield Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Li","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Zazai","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhay","family":"Bajpai","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia","family":"Zuberi","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Norman","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Leung","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8533-2140","authenticated-orcid":false,"given":"Mark James","family":"Specterman","sequence":"additional","affiliation":[{"name":"City St George\u2019s University of London, London, UK"},{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manav","family":"Sohal","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah R","family":"Behr","sequence":"additional","affiliation":[{"name":"City St George\u2019s University of London, London, UK"},{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdi","family":"Saba","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riyaz A","family":"Kaba","sequence":"additional","affiliation":[{"name":"City St George\u2019s University of London, London, UK"},{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"},{"name":"Royal Holloway University of London, Egham, 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