{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:22:53Z","timestamp":1791397373330,"version":"4.3.3"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Wide antral circumferential ablation (WACA) in comparison to ostial pulmonary vein (PV) isolation (PVI) has been attributed with improved rhythm outcome. We investigated the feasibility, lesion formation, and rhythm outcome of WACA-PVI in comparison to ostial-PVI using pulsed field ablation (PFA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Symptomatic atrial fibrillation (AF) patients (69 years, 67% male; 67% paroxysmal AF) were prospectively enrolled into our single-center registry and underwent first-time ostial-PFA or WACA-PFA,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200915 each. In all patients, eight pulse trains (2\u2005kV\/2.5\u2005s, bipolar, biphasic, 4\u00d7 basket\/flower configuration each) were delivered to each PV. In WACA-PFA, two extra pulse trains in a flower configuration were added to the anterior and posterior antrum of the PVs. For comparison of PFA lesion size, pre- and post-ablation left atrial (LA) voltage maps were acquired using a multipolar spiral catheter together with a three-dimensional electroanatomic mapping system.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      WACA-PFA resulted in a significant larger lesion formation than ostial-PFA (45.5 vs. 35.1\u2005cm\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) with bilateral overlapping butterfly shape-like lesions and concomitant posterior LA wall isolation in 73% of patients. This was not associated with increased procedure time, sedation dosage, or exposure to radiation. One-year freedom from AF recurrence was numerically higher after WACA-PFA than ostial-PFA (94% vs. 87%) but not statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.68). No organized atrial tachycardias (ATs) were observed. Ostial-PFA patients more often underwent re-ablation due to recurrent AF episodes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>WACA-PFA is feasible and resulted in significantly wider lesion sets than ostial-PFA. Concomitant posterior LA wall isolation occurred as an epiphenomenon in the majority of patients. The WACA approach was associated with neither increased procedure and fluoroscopy times nor statistically significant differences in 1-year rhythm outcome. ATs were absent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2023.1217745","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T06:37:11Z","timestamp":1687761431000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation\u2014the butterfly effect"],"prefix":"10.3389","volume":"10","author":[{"given":"Roland R.","family":"Tilz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian H.","family":"Heeger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Vogler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Eitel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Feher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huong-Lan","family":"Phan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Mushfiq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin S.","family":"Popescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Zetzsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Traub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Hatahet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Mortensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Kuck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Kirstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2020","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.jacc.2019.04.021","article-title":"Pulsed field ablation for pulmonary vein isolation in atrial fibrillation","volume":"74","author":"Reddy","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.1161\/01.CIR.0000144459.37455.EE","article-title":"Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-lasso technique in paroxysmal atrial fibrillation","volume":"110","author":"Ouyang","year":"2004","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1161\/01.CIR.0000151289.73085.36","article-title":"Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double lasso technique","volume":"111","author":"Ouyang","year":"2005","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1016\/j.jacc.2011.09.076","article-title":"Histopathologic characterization of chronic radiofrequency ablation lesions for pulmonary vein isolation","volume":"59","author":"Kowalski","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1161\/CIRCEP.113.000922","article-title":"Comparative effectiveness of wide antral versus ostial pulmonary vein isolation: a systematic review and meta-analysis","volume":"7","author":"Proietti","year":"2014","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1161\/01.CIR.95.3.572","article-title":"A focal source of atrial fibrillation treated by discrete radiofrequency ablation","volume":"95","author":"Ja\u00efs","year":"1997","journal-title":"Circulation"},{"key":"B8","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1056\/NEJM199809033391003","article-title":"Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins","volume":"339","author":"Ha\u00efssaguerre","year":"1998","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/S0735-1097(02)01972-1","article-title":"Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies","volume":"40","author":"Marrouche","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3057","DOI":"10.1161\/CIRCULATIONAHA.107.690578","article-title":"Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study","volume":"115","author":"Arentz","year":"2007","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation","volume":"374","author":"Kuck","year":"2016","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1007\/s12181-017-0179-4","article-title":"Positionspapier der Deutschen Gesellschaft f\u00fcr Kardiologie zur Kardioanalgosedierung","volume":"11","author":"Tilz","year":"2017","journal-title":"Der Kardiologe"},{"key":"B13","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/j.jacep.2018.04.005","article-title":"Ablation of atrial fibrillation with pulsed electric fields: an ultra-rapid, tissue-selective modality for cardiac ablation","volume":"4","author":"Reddy","year":"2018","journal-title":"JACC Clin Electrophysiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/j.jacep.2021.02.014","article-title":"Pulsed field ablation of paroxysmal atrial fibrillation","volume":"7","author":"Reddy","year":"2021","journal-title":"JACC Clin Electrophysiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1016\/j.hrthm.2021.02.020","article-title":"Does pulsed field ablation regress over time? A quantitative temporal analysis of pulmonary vein isolation","volume":"18","author":"Kawamura","year":"2021","journal-title":"Heart Rhythm"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e007781","DOI":"10.1161\/CIRCEP.119.007781","article-title":"Preclinical evaluation of pulsed field ablation: electrophysiological and histological assessment of thoracic vein isolation","volume":"12","author":"Koruth","year":"2019","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1016\/j.jacc.2020.07.007","article-title":"Pulsed field ablation in patients with persistent atrial fibrillation","volume":"76","author":"Redd","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/j.jacep.2021.02.014","article-title":"Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II","volume":"7","author":"Reddy","year":"2021","journal-title":"JACC Clin Electrophysiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1111\/jce.15349","article-title":"Pulsed field ablation combined with ultra-high-density mapping in patients undergoing catheter ablation for atrial fibrillation: practical and electrophysiological considerations","volume":"33","author":"Gunawardene","year":"2022","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/europace\/euac111","article-title":"Characterization of circumferential antral pulmonary vein isolation areas resulting from pulsed-field catheter ablation","volume":"25","author":"Bohnen","year":"2022","journal-title":"Europace"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/europace\/euab150","article-title":"How does the level of pulmonary venous isolation compare between pulsed field ablation and thermal energy ablation (radiofrequency, cryo, or laser)?","volume":"23","author":"Kawamura","year":"2021","journal-title":"Europace"},{"key":"B22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1536\/ihj.20-301","article-title":"Quantification of left atrial fibrosis in patients after pulmonary vein isolation using the second generation cryoballoon","volume":"62","author":"Rottner","year":"2021","journal-title":"Int Heart J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1093\/europace\/euac050","article-title":"Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF","volume":"24","author":"Ekanem","year":"2022","journal-title":"EP Europace"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1217745\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T06:37:13Z","timestamp":1687761433000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1217745\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,26]]},"references-count":23,"alternative-id":["10.3389\/fcvm.2023.1217745"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1217745","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,26]]},"article-number":"1217745"}}