Circular-array pulsed field ablation achieved 100% acute bidirectional CTI block and significantly reduced time to CTI block to median 79 s versus 324 s with radiofrequency ablation (p < 0.001).
Observational (n=55)
Open-label
No
Does cavotricuspid isthmus ablation using a circular-array pulsed field ablation system improve procedural efficiency and achieve acute block compared to radiofrequency ablation in patients with atrial fibrillation/flutter?
Circular-array pulsed field ablation for the cavotricuspid isthmus is highly effective and faster than radiofrequency ablation, though prophylactic vasodilators may be necessary to prevent right coronary artery spasm.
Tasa de eventos absoluta: 100% vs 100%
Pulsed-field ablation (PFA) is a novel nonthermal energy source that has shown favorable procedural safety and efficiency in pulmonary vein isolation. However, its utility in cavotricuspid isthmus (CTI) ablation, particularly with circular-array catheters, remains uncertain. To evaluate the feasibility, acute efficacy, procedural characteristics, and complication profile of CTI ablation using a circular-array PFA system. This retrospective study included 55 consecutive patients who underwent CTI ablation with a circular PFA catheter. Procedural parameters—including comparisons with radiofrequency (RF) ablation—PQ intervals, voltage mapping, and adverse events were analyzed. Bidirectional CTI block was achieved in all patients. The median number of applications to achieve block was three, with a total of eight applications per case. The median time to block and total ablation time were significantly shorter than those observed with RF ablation (79 sec vs. 324 sec; p < 0.001, 291 sec vs. 432 sec; p = 0.003). High-density mapping demonstrated extensive low-voltage lesions, with a median minimum width of 18 mm (IQR: 12–23) and maximum width of 30 mm (IQR: 23–35). Coronary spasm occurred in three patients (5.5%) but resolved with vasodilators. CTI ablation performed in conjunction with atrial fibrillation ablation using a circular-array PFA system appears to be a feasible and time-efficient approach. In the absence of prophylactic vasodilator administration, coronary spasm was observed even with the circular-array PFA system, underscoring the need for further investigation under vasodilator-supported conditions. Circular-array PFA created extensive low-voltage lesions with short procedural time and achieved 100% acute CTI block. Procedural efficiency was unaffected by right atrial volume or CTI length, while coronary spasm occasionally occurred in the absence of vasodilators, warranting further evaluation under vasodilator pretreatment.
Ueno et al. (Fri,) conducted a observational in Patients with atrial fibrillation undergoing cavotricuspid isthmus ablation using circular-array pulsed field ablation catheter (n=55). Cavotricuspid isthmus ablation using circular-array pulsed field ablation (PFA) catheter (PulseSelect, Medtronic) vs. Radiofrequency ablation (historical cohort) was evaluated on Acute bidirectional cavotricuspid isthmus (CTI) block and procedural time metrics. Circular-array pulsed field ablation achieved 100% acute bidirectional CTI block and significantly reduced time to CTI block to median 79 s versus 324 s with radiofrequency ablation (p < 0.001).