Fluoroscopy-guided pulsed-field ablation for pulmonary vein isolation frequently resulted in insufficient isolation areas in left anterior antral segments (62.5-77.5% of patients).
Observational (n=40)
Does fluoroscopy-guided pulsed-field ablation result in sufficient circumferential antral pulmonary vein isolation areas in patients with atrial fibrillation?
Fluoroscopy-guided PFA-PVI frequently results in insufficient isolation in left anterior antral PV segments and enlarged isolation areas on the posterior wall/roof, suggesting a need for 3D mapping integration to optimize the procedure.
AIMS: The cornerstone of pulmonary vein (PV) isolation (PVI) is a wide-area circumferential ablation (WACA) resulting in an antral PVI area. Pulsed-field ablation (PFA) is a new nonthermal 'single-shot' PVI technique resulting in well-characterized posterior isolation areas. However, information on circumferential PVI area is lacking. Thus, we sought to characterize the circumferential antral PVI areas after PFA-PVI. METHODS AND RESULTS: Atrial fibrillation (AF) patients underwent fluoroscopy-guided PVI with a pentaspline PFA catheter. Ultra-high-density voltage maps using a 20-polar circular mapping catheter were created before and immediately after PVI to identify and quantify (i) insufficient isolation areas per antral PV segment (10-segment model) and (ii) enlarged left atrial (LA) isolation areas (beyond the antral PV segments) per LA region (8-region model). The PFA-PVI with pre- (5469 ± 1822 points) and post-mapping (6809 ± 2769 points) was performed in 40 consecutive patients age 62 ± 6 years, 25/40 (62.5%) paroxysmal AF. Insufficient isolation areas were located most frequently in the anterior antral PV segments of the left PVs (62.5-77.5% of patients) with the largest extent (median ≥0.4 cm2) located in the same segments (segments 2/5/8). Enlarged LA isolation areas were located most frequently and most extensively on the posterior wall and roof region (89.5-100% of patients; median 1.1-2.7 cm2 per region). CONCLUSION: Fluoroscopy-guided PFA-PVI frequently results in insufficient isolation areas in the left anterior antral PV segments and enlarged LA isolation areas on the posterior wall/roof, which both may be extensive. To optimize the procedure, full integration of PFA catheter visualization into three-dimensional-mapping systems is needed.
Bohnen et al. (Tue,) conducted a observational in Atrial fibrillation (n=40). Fluoroscopy-guided pulmonary vein isolation with a pentaspline pulsed-field ablation catheter was evaluated on Insufficient isolation areas per antral PV segment and enlarged left atrial isolation areas per LA region. Fluoroscopy-guided pulsed-field ablation for pulmonary vein isolation frequently resulted in insufficient isolation areas in left anterior antral segments (62.5-77.5% of patients).