{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:48:38Z","timestamp":1785588518770,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Aims: Various pulsed field ablation (PFA) systems are currently being developed. Recently, a novel CE-approved circular array PFA catheter (PulseSelect\u2122 PFA System, Medtronic, Minneapolis, MN, USA) was introduced. Data on this commercially available system are sparse. The aim was to elucidate real-world data assessing the feasibility, safety, and acute efficacy of pulmonary vein isolation (PVI) and ablation beyond PVI with this novel ablation system. Methods: Consecutive patients with paroxysmal and persistent atrial fibrillation (AF) undergoing first-time ablation with the circular PFA catheter were enrolled in this study. In patients with persistent AF and left atrial (LA) enlargement (LA area &gt; 20 cm2), additional left atrial roof ablation (LARA) was performed. Those with concomitant typical atrial flutter received adjunctive cavo-tricuspid isthmus (CTI) ablation. Results: A total of 100 AF patients were included (29% female, 50% persistent AF). Of these, 33 patients (33%) underwent adjunctive LARA, 1 patient (1%) received posterior wall isolation, and 6 patients (6%) required additional CTI ablation. The skin-to-skin procedural time averaged 66.3 \u00b1 13.8 min, while the fluoroscopy time and dose area product were 13.7 \u00b1 4.7 min and 6.8 \u00b1 4.9 Gycm2, respectively. Acute PVI was achieved in 100% of pulmonary veins. A bidirectional conduction block of the LARA and CTI lines was confirmed in all patients, and no major adverse events were reported. Conclusions: These real-world data demonstrate the feasibility, safety, and acute efficacy of PVI and ablation beyond PVI using a novel circular array PFA catheter in patients with atrial fibrillation and flutter. The system can easily be integrated with standard PVI workflows. Further and larger studies are warranted to assess the clinical long-term effectiveness and safety of this PFA system.<\/jats:p>","DOI":"10.3390\/jcm13226961","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T10:44:37Z","timestamp":1732013077000},"page":"6961","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Initial Real-World Experiences of Pulmonary Vein Isolation and Ablation of Non-Pulmonary Vein Sites Using a Novel Circular Array Pulsed Field Ablation Catheter"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4042-8331","authenticated-orcid":false,"given":"Joerg","family":"Yogarajah","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Hutter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Kahle","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Beaujean","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Tomic","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Hain","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Sossalla","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"},{"name":"Department of Cardiology, Medical Clinic I, Justus Liebig University Giessen, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Kuniss","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e010817","DOI":"10.1161\/CIRCEP.121.010817","article-title":"5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation","volume":"15","author":"Schmidt","year":"2022","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"euae134","DOI":"10.1093\/europace\/euae134","article-title":"State-of-the-art pulsed field ablation for cardiac arrhythmias: Ongoing evolution and future perspective","volume":"26","author":"Chun","year":"2024","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"euad185","DOI":"10.1093\/europace\/euad185","article-title":"EUropean real-world outcomes with Pulsed field ablatiOn in patients with symptomatic atRIAl fibrillation: Lessons from the multi-centre EU-PORIA registry","volume":"25","author":"Schmidt","year":"2023","journal-title":"Europace"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e010168","DOI":"10.1161\/CIRCEP.121.010168","article-title":"First-in-Human Experience and Acute Procedural Outcomes Using a Novel Pulsed Field Ablation System: The PULSED AF Pilot Trial","volume":"15","author":"Verma","year":"2022","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1161\/CIRCULATIONAHA.123.063988","article-title":"Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial","volume":"147","author":"Verma","year":"2023","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1002\/ca.23896","article-title":"Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis","volume":"35","author":"Bonczar","year":"2022","journal-title":"Clin. Anat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1002\/clc.23163","article-title":"Pulmonary vein anatomy addressed by computed tomography and relation to success of second-generation cryoballoon ablation in paroxysmal atrial fibrillation","volume":"42","author":"Mulder","year":"2019","journal-title":"Clin. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/europace\/euq388","article-title":"Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation","volume":"13","author":"Sorgente","year":"2011","journal-title":"Europace"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00395-010-0132-1","article-title":"Discrepant electrophysiological characteristics and calcium homeostasis of left atrial anterior and posterior myocytes","volume":"106","author":"Suenari","year":"2011","journal-title":"Basic. Res. Cardiol."},{"key":"ref_10","first-page":"1109","article-title":"Cryoballoon ablation of persistent atrial fibrillation: Feasibility and safety of left atrial roof ablation with generation of conduction block in addition to antral pulmonary vein isolation","volume":"19","author":"Kuniss","year":"2017","journal-title":"Europace"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1056\/NEJMoa1408288","article-title":"Approaches to catheter ablation for persistent atrial fibrillation","volume":"372","author":"Verma","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1001\/jama.2022.8831","article-title":"Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial","volume":"327","author":"Marrouche","year":"2022","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/jama.2022.23722","article-title":"Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA Randomized Clinical Trial","volume":"329","author":"Kistler","year":"2023","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.jacep.2022.03.012","article-title":"Circumferential Pulmonary Vein Isolation Plus Low-Voltage Area Modification in Persistent Atrial Fibrillation: The STABLE-SR-II Trial","volume":"8","author":"Yang","year":"2022","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"EVIDoa2200141","DOI":"10.1056\/EVIDoa2200141","article-title":"Low-Voltage Myocardium-Guided Ablation Trial of Persistent Atrial Fibrillation","volume":"1","author":"Huo","year":"2022","journal-title":"NEJM Evid."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1093\/eurheartj\/ehl093","article-title":"Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: A prospective randomized comparison","volume":"27","author":"Willems","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1161\/CIRCEP.113.001251","article-title":"Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation","volume":"7","author":"Rolf","year":"2014","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.ijcard.2019.04.091","article-title":"Clinical outcome and left atrial function after left atrial roof ablation using the cryoballoon technique in patients with symptomatic persistent atrial fibrillation","volume":"292","author":"Akkaya","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jacep.2020.08.016","article-title":"Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation","volume":"7","author":"Aryana","year":"2021","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s10840-020-00887-8","article-title":"Long-term durability of posterior wall isolation using the cryoballoon in patients with persistent atrial fibrillation: A multicenter analysis of repeat catheter ablations","volume":"62","author":"Aryana","year":"2021","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1007\/s00392-019-01560-5","article-title":"Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon: Benefit or wasted time?","volume":"109","author":"Kuniss","year":"2020","journal-title":"Clin. Res. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"euae160","DOI":"10.1093\/europace\/euae160","article-title":"Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: Feasibility and safety in patients undergoing atrial fibrillation catheter ablation","volume":"26","author":"Ollitrault","year":"2024","journal-title":"Europace"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.jacep.2024.01.017","article-title":"Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation","volume":"10","author":"Turagam","year":"2024","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1161\/CIRCULATIONAHA.122.061497","article-title":"Coronary Arterial Spasm During Pulsed Field Ablation to Treat Atrial Fibrillation","volume":"146","author":"Reddy","year":"2022","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","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":"ref_26","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1161\/CIRCEP.123.011920","article-title":"Pulsed Field Versus Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation: Efficacy, Safety, and Long-Term Follow-Up in a 400-Patient Cohort","volume":"16","author":"Urbanek","year":"2023","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/CIRCULATIONAHA.123.064959","article-title":"Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry","volume":"148","author":"Turagam","year":"2023","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e004672","DOI":"10.1161\/CIRCEP.116.004672","article-title":"Acute and Long-Term Effects of Full-Power Electroporation Ablation Directly on the Porcine Esophagus","volume":"10","author":"Neven","year":"2017","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.hrthm.2021.02.015","article-title":"Absence of (sub-)acute cerebral events or lesions after electroporation ablation in the left-sided canine heart","volume":"18","author":"Neven","year":"2021","journal-title":"Heart Rhythm."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1007\/s10840-023-01728-0","article-title":"Left atrial posterior wall isolation using pulsed-field ablation: Procedural characteristics, safety, and mid-term outcomes","volume":"67","author":"Badertscher","year":"2024","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gunawardene, M.A., Frommeyer, G., Ellermann, C., Jularic, M., Leitz, P., Hartmann, J., Lange, P.S., Anwar, O., Rath, B., and Wahedi, R. (2023). Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196304"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1001\/jamacardio.2023.4405","article-title":"Coronary Artery Spasm During Pulsed Field vs Radiofrequency Catheter Ablation of the Mitral Isthmus","volume":"9","author":"Zhang","year":"2024","journal-title":"JAMA Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1038\/s41591-024-03114-3","article-title":"Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study","volume":"30","author":"Ekanem","year":"2024","journal-title":"Nat. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"euad371","DOI":"10.1093\/europace\/euad371","article-title":"Severe acute kidney injury related to haemolysis after pulsed field ablation for atrial fibrillation","volume":"26","author":"Venier","year":"2024","journal-title":"Europace"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Popa, M.A., Venier, S., Men\u00e8, R., Della Rocca, D., Sacher, F., Derval, N., Hocini, M., Dulucq, S., Caluori, G., and Combes, S. (2024). Characterization and Clinical Significance of Hemolysis After Pulsed Field Ablation for Atrial Fibrillation: Results of a Multicenter Analysis. Circ. Arrhythm. Electrophysiol., e012732.","DOI":"10.1161\/CIRCEP.124.012732"},{"key":"ref_36","first-page":"S1547-5271(24)03117-5","article-title":"Redefining the blanking period after pulsed-field ablation in patients with atrial fibrillation","volume":"21","author":"Mohanty","year":"2024","journal-title":"Heart Rhythm."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6961\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:35:06Z","timestamp":1760114106000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,19]]},"references-count":36,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226961"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226961","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,19]]}}}