This session, chaired by Roderik Tung (Phoenix, US), shares real-world strategies for managing persistent and long-standing persistent atrial fibrillation using dual-energy radiofrequency (RF) and pulsed field ablation (PFA). Helmut Perfelner (Linz, AT) presents several cases and walks through a practical, evidence-based approach to substrate-guided ablation.
The session highlights how patient-specific mapping, rather than empirical lesion sets, is becoming central to modern AF ablation. Drawing on the ERASE-AF trial, Helmut Perfelner explains why PVI alone is sufficient in nearly two-thirds of persistent AF patients, who show no low-voltage substrate - and why tailored substrate modification improves outcomes when abnormalities are present.
The session concludes with expert commentary from the panel; Alexandre Almorad (Brussels, BE) and Jonathan Lyne (Dublin, IR), discussing how results depend on precise mapping, complete lesion sets, and a truly individualised ablation strategy.
