Key result
Novel multipolar PFA catheter assesses PVI with ~97% accuracy at lower pacing outputs.
Why the study?
To validate the performance of a newly available multipolar PFA catheter compared to a standard pentaspline 3D-mapping catheter for endpoint assessment of PVI.
Does a novel multipolar PFA catheter accurately assess pulmonary vein isolation compared to a standard pentaspline 3D-mapping catheter in patients undergoing first PVI?
Observational (n=56)
Does a novel multipolar PFA catheter accurately assess pulmonary vein isolation compared to a standard pentaspline 3D-mapping catheter in patients undergoing first PVI?
A novel multipolar PFA catheter provides highly accurate real-time endpoint assessment for pulmonary vein isolation, with accuracy improving to 97% when pacing output is lowered to avoid far-field capture.
May aid real-time PVI assessment during procedures; leaves open whether accuracy gains improve outcomes in randomized trials.
AIMS: To validate the performance of a multipolar pulsed-field ablation (PFA) catheter compared to a standard pentaspline 3D-mapping catheter for endpoint assessment of pulmonary vein isolation (PVI). PFA for PVI using single-shot devices combines the benefits of high procedural efficacy and safety. A newly available multipolar PFA catheter allows real-time recording of pulmonary vein (PV) signals during PVI. METHODS AND RESULTS: Patients undergoing first PVI using PFA with the standard ablation protocol (eight applications per PV) were studied. Entrance and exit block (10 V/2 ms) were assessed using the PFA catheter. Subsequently, a high-density 3D electroanatomical bipolar voltage map (3D-EAM) was constructed using a standard pentaspline 3D-mapping catheter. Additional PFA applications were delivered only after confirmation of residual PV connection by 3D-EAM. In 56 patients, 213 PVs were targeted for ablation. Acute PVI was achieved in 100% of PVs: in 199/213 (93%) PVs with the standard ablation protocol alone and in the remaining 14 PVs after additional PFA applications. The accuracy of PV assessment with the PFA catheter after the standard ablation protocol was 91% (194/213 veins). In 5/213 (2.3%) PVs, the PFA catheter incorrectly indicated PV-isolation. In 14/213 (6.6%), the PFA catheter incorrectly indicated residual PV-conduction due to high-output pace-capture. Lowering the output to 5 V/1 ms reduced this observation to 0.9% (2/213) and increased the overall accuracy to 97% (206/213). CONCLUSION: A novel multipolar PFA catheter allows reliable endpoint assessment for PVI. Due to its design, far-field sensing and high-output pace-capture can occur. Lowering the pacing output increases the accuracy from 91 to 97%.
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Kueffer et al. (2022) conducted an observational in Pulmonary vein isolation (n=56). Multipolar pulsed-field ablation (PFA) catheter vs. Standard pentaspline 3D-mapping catheter was evaluated on Accuracy of PV assessment with the PFA catheter. A novel multipolar pulsed-field ablation catheter demonstrated 91% accuracy for endpoint assessment of pulmonary vein isolation, which increased to 97% when pacing output was lowered to 5 V/1 ms.
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