{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:48:19Z","timestamp":1781765299820,"version":"3.54.5"},"reference-count":22,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"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: Pulsed field ablation [PFA] is a novel ablation technique for pulmonary vein isolation [PVI] in patients with paroxysmal and persistent atrial fibrillation. However, data for the efficacy and safety of PFA for left atrial substrate modification using a single shot PFA system, in patients with long-standing persistent atrial fibrillation [AF] and left atrial macro- as well as micro-reentrant atrial tachycardia [LAMRT], are scarce. Here, we provide a small, single-center case series regarding the efficacy and safety of left atrial substrate modification using a single-shot PFA system. Methods: Nine patients with long-standing persistent AF and LAMRT underwent redo-PVI and left atrial substrate modification using a single-shot PFA system. Patients were subsequently followed up for 1 year. Results: The median age was 64 years [IQR 55.5\u201375], with 44% of the participants being female. The median time since the first diagnosis of AF was 7 years [IQR 4\u201315.5]. After re-PVI, posterior wall isolation was performed in five patients, roof isolation in six patients, and anterior wall ablation between the superior mitral annulus and the right superior pulmonary vein [RSPV] in five patients. In two patients, cavotricuspid isthmus ablation was additionally performed to treat typical atrial flutter. The acute procedural success rate was 100%, with all LAMRTs and typical flutters successfully terminating by ablation. At 1-year follow-up, four patients [44%] experienced a recurrence of any atrial arrhythmia. Median time to recurrence was 164 days [138\u2013212.8]. Importantly, no acute or chronic complications were observed. Conclusions: In this small, single-center case series, left atrial substrate modification for long-standing persistent AF and AT using a single-shot PFA system was safe and showed an excellent acute success rate.<\/jats:p>","DOI":"10.3390\/jcm14061891","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T16:39:03Z","timestamp":1741711143000},"page":"1891","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Left Atrial Substrate Modification for Long-Standing Persistent Atrial Fibrillation and Left Atrial Macro- or Micro-Reentrant Tachycardia Using a Single-Shot Pulsed Field Ablation System\u2014A Case Series"],"prefix":"10.3390","volume":"14","author":[{"given":"Paul","family":"Lustig","sequence":"first","affiliation":[{"name":"University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonghui","family":"Lee","sequence":"additional","affiliation":[{"name":"University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9016-2975","authenticated-orcid":false,"given":"Michael","family":"Sponder","sequence":"additional","affiliation":[{"name":"University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnter","family":"Stix","sequence":"additional","affiliation":[{"name":"University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8284-2994","authenticated-orcid":false,"given":"Christian","family":"Hengstenberg","sequence":"additional","affiliation":[{"name":"University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8411-9716","authenticated-orcid":false,"given":"Robert","family":"Sch\u00f6nbauer","sequence":"additional","affiliation":[{"name":"University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4285-5416","authenticated-orcid":false,"given":"Stefan","family":"Stojkovic","sequence":"additional","affiliation":[{"name":"University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","article-title":"Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study","volume":"129","author":"Chugh","year":"2014","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1093\/europace\/euy034","article-title":"Novel concepts and approaches in ablation of atrial fibrillation: The role of non-pulmonary vein triggers","volume":"20","author":"Gianni","year":"2018","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00399-021-00836-6","article-title":"Late arrhythmia recurrence after atrial fibrillation ablation: Incidence, mechanisms and clinical implications","volume":"33","author":"Erhard","year":"2022","journal-title":"Herzschrittmachertherapie Elektrophysiologie"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jacep.2017.08.012","article-title":"Biatrial Electrical and Structural Atrial Changes in Heart Failure: Electroanatomic Mapping in Persistent Atrial Fibrillation in Humans","volume":"4","author":"Prabhu","year":"2018","journal-title":"JACC Clin. 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