Tailor‐Made Hybrid Pulsed‐Field and Radiofrequency Ablation Guided by ExTRa Mapping for Refractory Long‐Standing Persistent Atrial Fibrillation: First Experience With the Affera System Prism‐2
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Pulmonary vein isolation (PVI) alone is frequently insufficient for persistent atrial fibrillation (AF). Although pulsed-field ablation (PFA) ensures durable linear lesions, extensive transmural ablation risks iatrogenic atrial tachycardia. A tailored strategy combining PFA with titrated radiofrequency (RF) energy for mild substrate homogenization remains poorly defined. Case Summary: A 77-year-old male with post-stroke refractory long-standing AF underwent a re-do ablation. Biatrial substrate evaluation was performed using the ExTRa mapping system, enabled by the Affera system (Prism-2) to visualize the nonmagnetic 20-pole spiral catheter. Areas with a mean non-passively activated ratio (%NP) ≥ 35% and low voltage (< 0.3 mV) were targeted. Following PFA-led posterior wall isolation, mild homogenization was performed using the Sphere-9 catheter with highly titrated RF energy (60%, 60°C, and 1-s duration). Although AF did not terminate directly, the AF cycle length significantly prolonged, and sinus rhythm was restored via cardioversion. Post-procedural mapping confirmed complete isolation without extensive dense scar formation at homogenization sites. The patient maintained sinus rhythm during follow-up. Conclusion: The hybrid PFA/RF system integrated with AI-driven phase mapping enables a safe, non-destructive, tailor-made substrate modification strategy for refractory persistent AF.
Source: Journal of Arrhythmia
DOI: 10.1002/joa3.70519
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,540
OpenAlex ID: W7225334881