Hirokami, JunJunHirokamiChun, Kyoung Ryul JulianKyoung Ryul JulianChunBordignon, StefanoStefanoBordignonTohoku, ShotaShotaTohokuNeven, KarsKarsNevenReichlin, TobiasTobiasReichlin0000-0002-7197-8415Blaauw, YuriYuriBlaauwHansen, JimJimHansenAdelino, RaquelRaquelAdelinoOuss, AlexandreAlexandreOussFüting, AnnaAnnaFütingRoten, LaurentLaurentRoten0000-0002-0827-1329Mulder, Bart ABart AMulderRuwald, Martin HMartin HRuwaldMené, RobertoRobertoMenévan der Voort, PepijnPepijnvan der VoortReinsch, NicoNicoReinschKueffer, ThomasThomasKueffer0000-0003-3553-4945Boveda, SergeSergeBovedaAlbrecht, Elizabeth MElizabeth MAlbrechtSchmidt, BorisBorisSchmidt2025-05-052025-05-052025-08https://boris-portal.unibe.ch/handle/20.500.12422/209492Background Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce. Objective This study aims to assess the efficacy and safety of PFA in patients with persistent AF. Methods Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected. Results The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87%), mitral isthmus ablation (37%), and cavo-tricuspid isthmus ablation (3%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69% vs. 56%, p = 0.013). While AF recurrence did not significantly differ (25% vs. 28%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8% vs. 22%, p < 0.001). Major complications occurred in 2.0% versus 1.0% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400). Conclusions PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.enatrial fibrillationextra pulmonary vein ablationpersistent AFpropensity score matchingpulmonary vein isolationpulsed‐field ablation600 - Technology::610 - Medicine & healtharticle10.48620/877694017179710.1111/jce.16583