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Related Experiment Video

Updated: Mar 14, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Electrogram-guided pulsed field ablation for persistent atrial fibrillation: A prospective cohort study.

Kaige Li1, Luigi Di Biase2, Mu Qin1

  • 1Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai Chest Hospital, Shanghai, China.

Heart Rhythm
|March 12, 2026
PubMed
Summary

This study shows electrogram (EGM)-guided pulsed field ablation (PFA) effectively treats persistent atrial fibrillation (PerAF). EGM-guided PFA achieved higher success rates and intra-procedural termination compared to standard PFA methods.

Keywords:
Catheter ablationCohort studyElectrogram-guided ablationPersistent atrial fibrillationPosterior wall isolationPulsed field ablationSubstrate modification

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Optimal ablation strategies for persistent atrial fibrillation (PerAF) using pulsed field ablation (PFA) are still being researched.
  • Current PFA techniques require refinement for improved efficacy in PerAF treatment.

Purpose of the Study:

  • To evaluate an innovative electrogram (EGM)-guided PFA approach for ablating persistent atrial fibrillation.
  • To compare the efficacy and safety of EGM-guided PFA versus standard PFA in PerAF patients.

Main Methods:

  • A prospective cohort study involving 170 patients with PerAF undergoing PFA.
  • Patients were divided into an EGM-guided PFA group (n=85) and a control PWI group (n=85).
  • EGM-guided PFA included pulmonary vein isolation (PVI), posterior wall isolation (PWI), and target EGM ablation; control group received anatomical PVI and PWI.

Main Results:

  • Intra-procedural AF termination occurred in 84.7% of the EGM group versus 11.8% in the PWI group (p<0.001).
  • At 12 months, AF/AT-free survival was significantly higher in the EGM group (82.4%) compared to the PWI group (65.9%; p=0.017).
  • Procedural AF termination correlated with higher AF/AT-free survival (84.1% vs 64.8%). One case of hemolysis reported in the EGM group.

Conclusions:

  • EGM-guided PFA shows preliminary efficacy and safety for PerAF ablation.
  • This innovative strategy holds promising potential for treating persistent atrial fibrillation.
  • Further research and clinical trials are warranted to confirm these findings.