Pulsed field ablation using focal contact force-sensing catheters for treatment of atrial fibrillation: acute and 90-day invasive remapping results

Figures

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  Figure 1. Configuration of the CENTAURI System in a standard EP laboratory. ECG, electrocardiogram; EP, electrophysiology.

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  Figure 2. Cohorts were established based upon ablation settings, ablation catheter, and mapping system used during the index ablation procedure.

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  Figure 3. Acute PVI and 90-day chronic PVI durability were assessed using high-density remapping to verify entrance and/or exit block. Voltage maps correlated with placement of PEF applications, and 90-day remaps confirmed no degradation of the line of block created at the index procedure. PEF, pulsed electric field; PVI, pulmonary vein isolation.

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  Figure 4. Chronic PFA lesion durability, measured by per-patient and per-PV isolation rate at 90 days, for each cohort. Patients in the PFA workflow development Cohorts 1 and 2 showed a per-patient isolation rate of 38% and 26%, and a per-pulmonary vein isolation rate of 47% and 53%, respectively. Patients in the optimized PFA Cohorts 3–5 showed a per-patient isolation rate of 60%, 73%, and 81% and a per-PV isolation rate of 84%, 90%, and 92%, respectively. There were no AEs associated with the optimization in energy settings and clinical workflows. PFA, pulsed field ablation; PV, pulmonary vein.

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  Figure 5. Points of reconnection along the PVs were addressed by delivering focal touch-up PFA using the CENTAURI System. As depicted in these examples, PV reconnections typically required minimal focal touch-up applications (a) posterior left PV carina indicated by red ablation tags, (b) epicardial sleeve posterior right carina, and (c) posterior right carina indicated by dotted ablation tags to re-isolate the vein, emphasizing the overall chronic durability of the WACAs created at the index procedure. PV, pulmonary vein; WACA, wide antral circumferential ablation.