Procedural characteristics, extent of acute antral lesion size, and myocardial injury with two different pulsed field ablation systems - the dual pulse system study

Background Recently, multiple pulsed field ablation (PFA)-system were introduced for catheter ablation (CA) of atrial fibrillation (AF). However, data comparing procedural performance, acute antral lesion size, and myocardial injury between different PFA-systems in a real-world setting remain scarce. Methods Consecutive patients undergoing CA for AF were enrolled. PFA was performed using either a Pentaspline catheter-system (PCS) or a loop catheter-system (LCS). The extent of acute antral lesion size was assessed using a 3D-electroanatomical mapping system. High-sensitivity cardiac troponin T (hs-cTnT) was measured the day after the procedure to assess myocardial injury. Results A total of 120 patients (median age 67 [59-73] years, 29% female) underwent de novo pulmonary vein isolation (PVI). The PCS-group included 90 patients, while the LCS-group included 30 patients. Acute PVI was achieved in all patients (100%). Procedural times were significantly shorter in the PCS compared to the LCS-group, including total procedure duration (57 [48-67] vs 66 [52–83] min, p=0.016), left atrial dwell time (38 [32–48] vs 54 [38–65] min, p<0.001), and ablation duration (17 [12–23] vs 24 [20–33] min, p<0.001). Acute antral lesion size and myocardial injury were significantly lower in the PCS compared to the LCS-group (6.6 [5.0–8.9] vs. 19.2 [16.8–25.4] cm², p<0.001 and hs-cTnT of 1282 [892-1894] vs 1588 [1281-2110] ng/L, p=0.029. Conclusion Significant differences were observed between two commercially available PFA-systems. While PCS was associated with significantly shorter procedural time, LCS resulted in a greater extent of acute antral lesion size and myocardial injury levels.