Versatility of the novel balloon-in-basket pulsed field ablation catheter: Pulmonary vein isolation and beyond.

BACKGROUND: Pulsed field ablation is an established energy source for catheter ablation (CA) of arrhythmias. Recently, a novel balloon-in-basket pulsed field ablation (BiBPFA) catheter has been introduced; however, its use beyond pulmonary vein isolation (PVI) has not yet been studied. OBJECTIVE: This study aimed to demonstrate the feasibility of versatile CA of atrial fibrillation, atrial flutter (AFL), and atrial tachycardia (AT) using the novel BiBPFA catheter. METHODS: Consecutive patients undergoing CA, including index and repeat procedures, using the novel BiBPFA catheter in a single center from June 2025 to March 2026 were analyzed. CA involved PVI/re-PVI, cavotricuspid isthmus ablation, and left atrial substrate modification, including anterior lines, roof lines, posterior wall isolation, and focal ablation. Endpoints included acute procedural success and procedural safety. RESULTS: A total of 42 patients were included (age 68.4 ± 9.7 years; CHA2DS2-VA score 2.4 ± 1.4; 77.8% males; 64.3% persistent atrial fibrillation; 16.7% with AFL; 9.5% with AT) in this study. CA included the isolation/reisolation of 231 pulmonary veins (14.4 ± 3.3 applications), 7 cavotricuspid isthmus ablations (10.6 ± 8.1 applications), and left atrial substrate modification, including 1 anterior line (12 applications), 6 roof lines (6 ± 1.6 applications), 9 posterior wall isolations (15.3 ± 6), and 1 focal ablation (8 applications). Acute procedural success was achieved in all 42 patients (100%). No procedural complications occurred. CONCLUSION: Initial experience with the novel BiBPFA catheter suggests broad procedural versatility beyond PVI, enabling effective mapping and ablation of ATs and right AFL and atrial substrate modification using a single-device approach.