Fluoroscopy-free atrial fibrillation ablation using pulsed field ablation system

Abstract Background Pulsed field ablation (PFA) has emerged as a non-thermal, tissue-selective modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF) treatment, potentially minimizing collateral damage to adjacent structures. The VARIPULSE™ PFA system, integrated with the CARTO™ 3 electroanatomical mapping system, facilitates real-time catheter visualization, enabling procedures with minimal or no fluoroscopy. Objective To evaluate the feasibility and acute safety of performing zero-fluoroscopy AF catheter ablation using the VARIPULSE™ PFA system in a cohort of 100 patients with paroxysmal or persistent AF. Methods A prospective, single-center study was conducted involving consecutive patients undergoing AF ablation (PVI +/- linear ablations) with the VARIPULSE™ system. Procedures were guided exclusively by the CARTO™ 3 system, without the use of fluoroscopy. Data on procedural parameters, acute success rates, and complications were collected and analyzed. Results 121 consecutive patients were included in the study with 60% of paroxysmal AF. Additional extra-pulmonary vein ablation (CTI or posterior wall isolation or both) was performed in 93 patients (76.9%), The mean time procedure was 44.5 ± 15.2 minutes. The success rate of zero-fluoroscopy was 98,4%. 2 patients had an acute complication (1 TIA and 1 cardiogenic shock). Conclusion Our initial experience suggests that fluoroscopy-free PVI using the VARIPULSE™ PFA system is both feasible and safe, offering a radiation-free alternative for AF ablation. But it also demonstrates the efficiency of this workflow with a reduced procedure time compared to other studies. Further studies are warranted to assess long-term outcomes and broader applicability.