PFA offers a faster and safe alternative to conventional radiofrequency ablation (RFA) for anterior mitral isthmus (MIL) ablation, according to a prospective single-center analysis from the SWISS-AF-PVI registry published in EP Europace.

The study included 129 patients (median age 70 years; 40% female) who underwent pulmonary vein isolation with additional anterior MIL ablation. Among them, 61 received PFA using a pentaspline catheter, and 68 underwent RFA with a 3.5 mm irrigated tip catheter.

PFA markedly shortened total procedure time (71 vs. 108 minutes; p < 0.001), left atrial dwell time (53 vs. 80 minutes; p < 0.001), and ablation time (27 vs. 50 minutes; p < 0.001) compared with RFA. Fewer applications were required for PFA (14 applications, 35 seconds total) versus RFA (473 seconds).

At a median follow-up of 327 days, arrhythmia-free survival was similar between groups (PFA 48.8% vs. RFA 61.8%; p = 0.34). Among 34 patients who underwent redo procedures, incomplete MIL lesions were detected in 53% of cases, with no significant difference between ablation methods. Three major complications occurred overall, confirming procedural safety.

Although PFA improves efficiency and maintains comparable arrhythmia outcomes, high rates of MIL reconnection highlight the need for strategies that enhance lesion durability and long-term efficacy.