Confirmation of catheter-tissue contact with intra-cardiac echocardiography during pulsed-field ablation improves procedure outcome in patients with atrial fibrillation

Introduction Catheter-tissue contact is critical in creating durable lesions during pulsed-field ablation (PFA) of atrial fibrillation (AF). We aimed to compare the reconnection rate of previously ablated targets utilizing PFA with vs without intracardiac echocardiography (ICE)-guidance for confirmation of tissue contact. Methods This multicenter prospective study included consecutive paroxysmal and persistent AF patients undergoing their first procedure using the PFA system. Patients were classified as group 1 if ICE was used for assessment of catheter-tissue-contact (n=329) or group 2 if ICE was not utilized to evaluate tissue-contact (n=286). All patients received isolation of PVs (PVI) and left atrial posterior wall (LAPW) at the index procedure. Additional ablations were performed only in the presence of spontaneous triggers or documentation that those triggers were responsible for arrhythmia either spontaneously or after isoproterenol challenge. Results Baseline characteristics were comparable between the groups. At the end of the follow-up, arrhythmia recurrence was noted in 42 (12.7%) and 64 (22.3%) patients in group 1 and 2 respectively (p=0.002) (Figure 1). All 42 patients in group 1 and 54 (84%) patients in group 2 received repeat ablation. At the redo procedure, reconnection of previously ablated structures was detected in 5/42 (11.9%) and 32/54 (59.2%) patients in group 1 and 2 respectively (p<0.001). ‘Ablation without ICE guided catheter-tissue contact assessment’ was found to be an independent predictor of reconnection (OR =6.001, 95% CI 2.761 – 15.991, p- value = <0.001) as well as recurrence (OR: 1.221, 95% CI 1.001 - 1.971, p=0.021). Conclusion ICE-guided PFA with confirmed catheter-tissue contact was associated with better success rate and significantly lower reconnection rate following ablation for AF.