The balloon-in-basket(BiB) pulsed field ablation(PFA) system integrates real-time electroanatomic mapping and contact sensing to streamline workflows, but clinical experience remain limited. The aim was to descriptively evaluate procedural performance, acute safety, and feasibility of the BiB-PFA-system in consecutive atrial fibrillation(AF) patients treated at a high-volume electrophysiology center. This prospective study included the first 100 consecutive patients undergoing pulmonary vein isolation(PVI) with the BiB-PFA-system between 01/2024 and 10/2025. The initial 30 patients were part of VOLTTM-CE-Mark-study and 25 of VOLTTM-CE-Mark-extended-study. It included a 20-minute waiting periode, pre-/postablation left-atrial mapping and phrenic nerve pacing; subsequent procedures relied solely on BiB-PFA-system. Additional linear or extra-pulmonary ablations were performed at operator discretion. Follow-up(≥ 6 months) as per institutional standart was available in 52 patients. Patients were 68[62;76] years old, 41

Epicardial access is often required for catheter ablation of ventricular tachycardia (VT) when arrhythmogenic substrates are located on the epicardial surface, but it is associated with potentially serious complications, including cardiac tamponade and coronary artery injury. The use of a needle-in-needle (NiN) micropuncture technique for percutaneous epicardial access may reduce myocardial trauma and improve procedural safety. We aimed to describe a standardized workflow and assess the feasibility and acute safety of epicardial access for VT ablation using a NiN micropuncture technique. This retrospective, single-center observational study without a comparator group included 40 consecutive patients who underwent epicardial access for VT ablation using the NiN micropuncture technique between January 2020 and July 2025. Baseline clinical characteristics, procedural details, success of epicardial access, and acute access-related complications were evaluated. Nurse-administered propofol sedation was used in 37 patients (93

Background:The balloon-in-basket pulsed field ablation (BiB-PFA) system is a novel modality that achieves myocardial-selective ablation with minimal collateral tissue injury. Sex-related differences in biomarker responses following BiB-PFA-guided pulmonary vein isolation (PVI) for atrial fibrillation (AF) remain unclear. Objective:We aimed to investigate sex-based differences in peri-procedural biomarker responses and procedure-related complications among patients undergoing PVI alone using the BiB-PFA system. Methods:We retrospectively analyzed patients undergoing initial PVI with the BiB-PFA system between January 2024 and March 2026. Peri-procedural inflammatory, myocardial injury, hemolysis, and renal biomarkers were assessed pre-ablation and on the first post-procedural day. Sex-based differences in biomarker changes (Δ = post - pre) and procedural safety outcomes were compared. Results:A total of 50 patients were included (50% female). Baseline characteristics and procedural parameters were comparable between groups. Δ values in inflammatory markers (Δwhite blood cell count: P = 0.813; ΔC-reactive protein: P = 0.343), myocardial injury markers (Δcreatine kinase: P = 0.261; Δtroponin T: P = 0.078), hemolysis markers and renal function parameters (Δtotal bilirubin: P = 0.160; Δhaptoglobin: P = 0.104; Δestimated glomerular filtration rate: P = 0.984; Δmyoglobin: P = 0.258) did not differ significantly between female and male patients. Procedure-related complications were rare and showed no sex-related differences. Conclusions:No statistically significant sex-related differences were detected in peri-procedural biomarker responses or observed procedural complications following BiB-PFA-guided PVI.

BACKGROUND:Catheter ablation is an established therapy for arrhythmias. As the incidence of atrial fibrillation (AF) rises, the associated burden on the health-care system is expected to increase. Same-day discharge (SDD) may help optimize resource utilization and increase patient comfort and satisfaction. METHODS:Consecutive patients undergoing SDD electrophysiology procedures were prospectively enrolled in the study and compared in a non-randomized manner with consecutive overnight stay (ONS) patients who were matched to them according to procedure type. SDD patients were evaluated on the day after the procedure. SDD Patients who were not discharged on the day of the procedure were excluded. Baseline, periprocedural, and 30-day outcomes were documented and compared. RESULTS:100 patients underwent SDD electrophysiology procedures from September 2022 to March 2025. The SDD patients were younger and had a lower prevalence of coronary artery disease and chronic kidney disease than their counterparts in the ONS cohort. The most common procedure was AF ablation. Procedural complications arose in 2% (95% confidence interval: [0.6; 7.0]) vs. 6% [2.8; 12.5] in SDD and ONS patients, respectively, p =0.279. Complications up to the day of discharge, or up to the evaluation on post-procedure day 1 in the SDD group were reported in 10% [5.5; 17.4] and 17% [10.9, 25.6] of patients, respectively, p = 0.214. Complications were identified on post-procedure day 1 in 8 SDD patients, none of whom needed to be readmitted to the hospital. The numbers of emergency room consultations, unplanned outpatient visits, and rehospitalizations were similar in the two groups. In a subsequent analysis from January to May 2026, 85.8% of patients scheduled for SDD ablation were successfully discharged on the day of the procedure. CONCLUSION:In this prospective study, SDD after electrophysiology procedures was found to be a safe alternative to ONS in selected patients. None of the patients who were discharged on the same day as the procedure needed to be rehospitalized on the day after.

Catheter ablation for the treatment of typical atrial flutter (AFL) provides effective and durable cavotricuspid isthmus (CTI) block associated with encouraging clinical outcome. Safety and efficacy of very high-power short-duration (vHPSD) temperature-controlled radiofrequency (RF) CTI ablation with 90 watts over 4 s (90 W/4 s) for typical AFL in comparison to conventional contact-force (CF) ablation-index (AI) guided ablation remains insufficiently investigated. This single-center observational cohort study based on prospectively collected registry data included 100 consecutive patients undergoing CTI ablation for symptomatic typical AFL, with 50 patients treated using a vHPSD strategy (vHPSD-group) and 50 patients using an AI-guided ablation approach (AI-group). All CTIs were successfully blocked using either method. Median RF applications and RF times in the vHPSD-group and AI-group were 36 [IQR 26;47] versus 18 [IQR 12;26], p < 0.001 and 142 s [IQR 105;189 s] versus 574 s [IQR 401;983], p < 0.001, respectively. No differences in periprocedural complications were observed. Recurrence of AFL after 12 months was low with no significant differences between groups (2

BACKGROUND:Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) for atrial fibrillation (AF) is becoming increasingly widespread. However, characteristics of atrial tachycardia (AT) recurrence after PFA remain unclear. We aimed to investigate characteristics of AT recurrence in comparison with AF recurrence after PFA-based PVI. METHODS:We analyzed 60 consecutive patients who underwent repeat ablation for recurrent atrial tachyarrhythmia after initial PVI alone performed with a pentaspline PFA system. Patients were classified into an AT group (at least one AT episode before repeat ablation) and an AF group (AF recurrence only). Baseline characteristics, pulmonary vein (PV) reconnections, and recurrence-free rate after repeat ablation procedure were assessed. RESULTS:The AT group consisted of 34 patients (57%). In the multivariate analysis, absence of PV reconnections was independently associated with AT recurrence (p = 0.037). All mappable ATs were macro-reentrant circuits and none were directly related to PVs. Recurrence-free rate after repeat ablation did not differ between AT and AF groups (p = 0.277). However, patients presenting in AT at the beginning of the repeat procedure had the most favorable outcomes, whereas those in AF had the poorest (p = 0.042). CONCLUSIONS:After PFA-based PVI, AT recurrence was characterized by lower PV reconnection rates and macro-reentrant circuits remote from the PVs, whereas AF recurrence was more frequently associated with PV reconnections. While overall outcomes after repeat ablation were comparable, baseline rhythm at the repeat procedure was associated with prognosis, underscoring the importance of tailored mapping and ablation strategies after PFA.

Balloon-in-basket pulsed field ablation (BiB-PFA) enables atrial fibrillation (AF) ablation under conscious sedation (CS). While augmented reality (AR) has been proposed to improve patient comfort during invasive procedures, its benefit in an already well-tolerated awake ablation setting remains uncertain. To evaluate the impact of adjunctive AR glasses on sedation requirements and patient comfort during BiB-PFA performed under CS. In this prospective, single-center study, 50 patients undergoing AF ablation with BiB-PFA were treated under a standardized CS protocol. Patients were allocated to either ablation without AR (n = 25) or ablation with adjunctive AR glasses (n = 25). Sedation requirements and patient-reported outcomes were assessed during ablation, as well as at 1-hour and 1-day post-procedure. Baseline characteristics were comparable. All procedures were completed without conversion to deep sedation. Fentanyl requirements were lower in AR-group (1.1 vs. 1.4 µg/kg; p = 0.015), while other sedatives were similar. Intraprocedural pain was moderate and comparable. AR enhanced perceived calming effect (10.0 vs. 8.5; p = 0.015). Satisfaction was high in both groups. Recommendation scores were high overall, with higher values without AR (90(90,100) vs. 90 (70,90); p = 0.023). Retrospective anxiety at day 1 remained low but was higher with AR (2.0(0.0,5.0) vs. 0.0 (0.0,0.0); p = 0.002). Pain decreased over time in both (p < 0.001). CS for BiB-PFA is feasible and well tolerated. Intraprocedural pain was low, while satisfaction and recommendation were high in both groups, with slightly higher values without AR support. AR use was associated with modest reduced opioid requirements, suggesting a potential role in selected patients. Slightly higher retrospectively reported anxiety at 1 day in AR-group, while overall low, warrants further investigation.

Background:Superior vena cava (SVC) is one of the most important non-pulmonary vein (PV) foci in patients with atrial fibrillation (AF), but ablation at this site carries risks of phrenic nerve injury and sinus node dysfunction. Balloon-in-basket (BiB)-pulsed field ablation (PFA) is a novel nonthermal system offering stable wall contact and simultaneous mapping, yet its use for SVC isolation has not been well established. Objective:This study described a standardized workflow and initial results of SVC isolation using the BiB-PFA system. Methods:We included patients who underwent de novo PV isolation and SVC isolation using the BiB-PFA system. SVC isolation was performed using a standardized workflow including electroanatomic mapping, phrenic nerve pacing, selective voltage adjustment (1800 or 1400 V), and systematic remapping. Baseline characteristics, procedural details, and acute safety outcomes were evaluated. Results:A total of 10 patients (median age 78 years, 4 women, and 2 with paroxysmal AF) were analyzed. Acute PV isolation and SVC isolation were achieved in all patients. 1 patient developed transient sinus node arrest immediately after the first application for SVC, which resolved with isoprenaline without pacemaker implantation. No persistent sinus node dysfunction or phrenic nerve palsy occurred. Conclusion:We described a standardized, reproducible strategy for SVC isolation using the BiB-PFA system. In this initial experience, the strategy was feasible and safe, with acute success in all patients and only 1 transient adverse event. These findings suggest that the BiB-PFA system may represent a promising tool for adjunctive SVC ablation in AF.

BackgroundCatheter based left atrial linear lesion ablation is commonly performed in patients with atrial fibrillation (AF) and complex left atrial substrate or in patients presenting with macro-reentrant left atrial tachycardia (LAT).AimsTo assess acute and long-term effectiveness, procedural viability and safety of ablation index (AI)-guided compared to contact force (CF)-guided ablation of left atrial linear lesions.MethodsConsecutive patients undergoing left atrial ablation for AF or LAT including left atrial linear lesions ablation either guided by AI or CF without AI were prospectively enrolled. Characteristics of anterior lines (AL), mitral isthmus lines (MIL), roof lines (RFL) and posterior wall isolation (PWI) were systematically analyzed in both cohorts. Procedural feasibility, safety, acute and long-term block of linear lesions as well as clinical outcome in terms of arrhythmia recurrence were assessed.ResultsA total of 313 patients were included. 260 patients (83.1%) underwent AI-guided ablation and 53 patients (16.9%) CF-guided ablation. Complete conduction block was comparable between study groups (94 vs. 95% for AL, 94 vs. 95% for AL100 vs. 99% for RFL and 100 vs. 100% for PWI). Acute block of MIL was significantly more often achieved in AI-guided ablation (100 vs. 67%, p = 0.0004). No significant difference in persistence of conduction block for AL (p = 0.47), MIL (p = 0.57), RFL (p = 0.18) or PWI (p = 1) could be observed between AI-guided or CF-guided ablation during repeat ablation. Survival analysis showed no significant differences in estimated arrhythmia free survival (p = 0.45). Periprocedural complications occurred in 22 patients (7%) with equal distribution in CF-guided and AI-guided ablation (p = 0.31).ConclusionAI-guided ablation is associated with significantly higher rates of acute conduction block across MIL, shorter RF times and lower FTI for AL and RFL while complication rates and long-term clinical outcome are comparable to non-AI-guided ablation.

Background Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF) and is typically performed via transfemoral access. In patients with interrupted inferior vena cava (IVC), however, alternative access routes such as the superior vena cava (SVC) approach are required. A balloon-in-basket (BiB)-pulsed field ablation (PFA) is a novel non-thermal ablation modality that offers stable positioning and uniform tissue contact.Case summary A 66-year-old man with symptomatic persistent AF, characterized by palpitations and interrupted, IVC was referred to our institution. Catheter ablation using a BiB-PFA system via the SVC approach was planned. Transseptal puncture was successfully achieved under transesophageal echocardiographic and fluoroscopic guidance. PVI was achieved using the BiB-PFA catheter. Additional left atrial posterior wall (LAPW) isolation was performed with selective electrode activation to avoid anterior wall delivery. The procedure was completed without complications. At the 3-month follow-up, no recurrence of atrial tachyarrhythmia was detected on Holter monitoring, and the patient remained asymptomatic.Discussion This case highlights the feasibility and safety of performing PVI and LAPW isolation via the SVC approach using the BiB-PFA system in a patient with interrupted IVC. The BiB-PFA system provides stable catheter manipulation and allows targeted lesion delivery through selective electrode activation. Although limited by its single-case nature and short follow-up, this report suggests that the BiB-PFA system may expand the therapeutic options for patients with complex venous anatomy.

Background: Atrial fibrillation (AF) remains the most common cardiac arrhythmia, with pulmonary vein isolation (PVI) established as the cornerstone of interventional treatment. However, in patients with persistent AF (PersAF), the success rates of PVI alone tend to be limited. A promising additional target is the left atrial appendage (LAA). In recent years, cryoballoon (CB) technology has become a tool for achieving durable PVI. Its application for LAAI has been investigated as a potentially advantageous alternative to radiofrequency ablation, and a positive effect on long-term outcome has been reported. However, the available data is limited. This study sought to investigate the clinical impact of CB-based LAAI in addition to PVI. Methods: This is a prospective, interventional, single-centre study. Consecutive patients with symptomatic PersAF were prospectively enrolled. In total 23 patients with PersAF underwent PVI plus LAAI using the CB system. Percutaneous LAA closure was performed within 2-3 months in all patients by implanting an endocardial LAA-closure device. Prior to LAA closure, LAAI durability was systematically assessed by invasive remapping studies. Results: A total of 100% of PVs were successfully isolated using the CB only (n = 91/91). Concerning LAAIs, a total of 21/23 (91%) remained isolated at the end of the procedure. After the ablation procedure including LAAI, all patients were scheduled for TEE assessment and LAA closure. TEE was performed after a mean of 54 ± 19 days. In 6/23 (26%) patients, LAA thrombus formation was detected after LAAI. A total of 23/23 patients (100%) received LAAC after a mean of 72 ± 45 days. Durability of LAAI was assessed utilizing a spiral mapping catheter in 23/23 patients (100%). In a total of 17/23 (74%) patients, durable LAA isolation was detected. Durable PVI of all PVs was detected in 16/23 (70%) patients. During a mean follow-up of 13 ± 3.4 months, stable sinus rhythm was maintained in 15 (65%) patients. The LAA showed reconnection in 3/23 (13%) patients, with arrhythmia recurrence. During follow-up, one stroke (318 days after LAAC) and one device thrombus (56 days after LAAC) occurred. Conclusions: While CB-based LAAI may offer benefits in managing persistent AF, it presents a significant risk of thrombus formation in the LAA, even with appropriate OAC. Early closure of the LAA following LAAI appears promising in mitigating these risks, but further evidence is needed to establish clear best practices.

Background Several reports have focused on repeat procedures after pulsed field ablation (PFA)–guided pulmonary vein isolation (PVI) for atrial fibrillation (AF). However, the electrophysiological recurrence patterns following balloon-in-basket (BiB)-PFA remain incompletely characterized. Objective To compare pulmonary vein (PV) durability, reconnection patterns, and mechanisms of arrhythmia recurrence after BiB-PFA versus cryoballoon ablation (CBA). Methods Consecutive patients undergoing repeat ablation procedures for recurrent atrial tachyarrhythmias after initial BiB-PFA or CBA were retrospectively analyzed. Propensity score matching (1:2) was performed using age, AF type, and left atrial volume index. During repeat procedures, all PVs were systematically assessed using high-density electroanatomical mapping. PV durability, reconnection patterns, and substrate characteristics were compared. Results After propensity score matching, 12 patients undergoing repeat procedures after BiB-PFA and 24 after CBA were included. Durable isolation of all PVs was significantly more frequent after BiB-PFA than after CBA (75% vs 38%, P=0.034). At the PV level, durable isolation was observed in 45/48 PVs (94%) after BiB-PFA versus 62/96 PVs (65%) after CBA (P<0.001). Reconnection after BiB-PFA was predominantly localized to the anterior or posterior aspects of the left-sided PVs, whereas CBA demonstrated broader reconnection patterns. Extensive low-voltage areas were more frequently observed during repeat procedures after BiB-PFA compared with CBA (P=0.035). Conclusions Repeat procedures after BiB-PFA demonstrated a distinct electrophysiological recurrence phenotype characterized by highly durable PVI, focal reconnection patterns, and substrate-related arrhythmia mechanisms compared with CBA. These findings suggest that recurrence after BiB-PFA increasingly reflects non-PV arrhythmogenic mechanisms rather than extensive lesion failure.

Background:A novel balloon-in-basket pulsed field ablation (BiB-PFA) catheter enables efficient pulmonary vein isolation (PVI) and allows posterior wall isolation (PWI) within the same procedure. The incremental biological effect of PWI compared to PVI alone remains uncertain, particularly regarding inflammation, myocardial injury, and hemolysis. Methods:In this prospective, single-center study, consecutive patients with atrial fibrillation underwent first-time BiB-PFA, either PVI only or PVI plus PWI. Venous blood samples were collected before and one day after ablation. Biomarkers included leukocytes, platelets, hemoglobin, C-reactive protein (CRP), haptoglobin, bilirubin, lactate dehydrogenase (LDH), creatinine, estimated glomerular filtration rate (GFR), myoglobin, creatine kinase (CK), and troponin T. Results:A total of 60 patients were enrolled (PVI only n = 30, PVI + PWI n = 30). Baseline characteristics were comparable. PVI + PWI required more applications (19 vs. 16; p < 0.001) but had similar procedure time. Both groups showed significant increases in inflammatory (CRP, leukocytes), myocardial (troponin T, CK, LDH, myoglobin), and hemolysis markers (bilirubin, LDH, haptoglobin changes; all p < 0.001). However, the magnitude of biomarker release did not differ between PVI only and PVI + PWI: Δ troponin T (1,154 vs. 1,029 ng/L, p = 0.694), Δ CK (217 vs. 197 U/L, p = 0.652), Δ CRP (2.7 vs. 3.4 mg/L, p = 0.475), Δ bilirubin (2.4 vs. 2.8 µmol/L, p = 0.842), Δ creatinine (3.3 vs. 9.0 µmol/L, p = 0.085). Conclusion:BiB-PFA PVI provokes systemic responses involving inflammation, myocardial injury, and hemolysis. Adjunctive PWI increases application number but does not further increase biomarker release, supporting the biological safety of PWI.

BackgroundPulsed-field ablation (PFA) is a non-thermal energy source for pulmonary vein isolation (PVI). Data comparing the biological impact of different PFA technologies remain limited. This study assessed changes in biomarkers of hemolysis, inflammation, and biochemical myocardial injury using two PFA systems: a balloon-in-basket (BiB) and a circular catheter (PS).MethodsThis prospective, single-center, non-randomized study enrolled consecutive patients undergoing first-time PVI. leukocytes, C-reactive protein (CRP), platelets, lactate dehydrogenase (LDH), haptoglobin, total bilirubin, troponin T, creatine kinase (CK), myoglobin, creatinine, and estimated glomerular filtration rate (eGFR) were before and 16–18 h after ablation.ResultsForty patients were included (BiB n = 20, PS n = 20). Baseline characteristics were comparable. Acute PVI was achieved in all cases. BiB required fewer applications (16 vs. 32, p < 0.001), more contrast (45 vs. 30 mL, p < 0.001), and had longer procedure and LA dwell times (p < 0.001). Both systems caused significant increases in leukocytes, CRP, LDH, troponin, and CK without inter-group differences. Haptoglobin decreased significantly in both, more pronounced with PS (Δ −13 vs. −4 mg/dL, p = 0.090). Renal function remained stable overall, with one PS patient developing an acute kidney injury. In the BiB group, Δ-Hemoglobin correlated inversely with application number (p = 0.046). In the PS group, Δ-Troponin and Δ-CK correlated positively (p < 0.05).ConclusionDespite comparable overall biomarker responses, a numerically greater, non-significant haptoglobin decline and an isolated, likely multifactorial transient AKI in the PS group may suggest differences in biomarker responses, warranting further investigation in larger studies. However, the clinical relevance of these findings remains uncertain.