Why the study?
Pulsed field ablation using a pentaspline catheter is increasingly applied for pulmonary vein isolation, but standardized methods to assess durable lesion formation are lacking.
Does stacking multiple pulsed field applications (quadruple vs single/double) improve durable acute lesion formation as measured by intracardiac electrogram characteristics and local pace capture in patients with atrial fibrillation?
Does stacking multiple pulsed field applications (quadruple vs single/double) improve durable acute lesion formation as measured by intracardiac electrogram characteristics and local pace capture in patients with atrial fibrillation?
Quadruple applications of pulsed field ablation prevent early electrogram recovery compared to single or double applications, and a bipolar voltage amplitude ≤0.28 mV can reliably confirm acute pulmonary vein isolation.
Background: Pulsed field ablation (PFA) using a pentaspline catheter is increasingly applied for pulmonary vein (PV) isolation, but standardized methods to assess durable lesion formation are lacking. Objective: We aimed to investigate the impact of incremental PFA applications on electrogram (EGM) characteristics and determine whether EGM signatures serve as markers for effective lesions. Methods: PV EGMs of a cohort of consecutive patients were analyzed before and after single, double, and quadruple PFA applications. Bipolar voltage amplitude (BVA) and signal power in different frequency bands (>50 Hz, >75 Hz, and >125 Hz [HF125]) were quantified. EGMs were reassessed after 60 seconds, and pacing was performed to evaluate PV pace capture. Results: and a BVA threshold of 0.28 mV. Conclusion: and BVA cutoff of 0.28 mV may provide accurate confirmation of PV isolation with the pentaspline catheter.
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Schlageter et al. (2026) studied this question.
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