Pulmonary vein isolation and beyond: Feasibility and acute outcomes of the lattice-tip dual-energy catheter for complex ablations

Background: A new large-footprint catheter that switches between pulsed field ablation (PFA) and radiofrequency ablation (RFA) and integrates with a novel 3-dimensional (3D) mapping platform has been introduced. Objective: This study aimed to evaluate the safety, efficacy, and procedural characteristics of the large-footprint dual-energy catheter in patients undergoing catheter ablation for atrial fibrillation or atrial tachycardia. Methods: Consecutive patients undergoing left (LA) and right atrial ablation for atrial fibrillation or atrial tachycardias were analyzed. All patients were enrolled in the prospective TRUST Registry (NCT05521451). Results: 102 patients (37 women [36%]; median age 68 years [60-75]; median left ventricular ejection fraction 60% [53-60]) were included; 42 (41%) underwent first pulmonary vein isolation (PVI), and 57 (56%) repeat PVI. Median procedure and mapping times were 91 minutes (78-114) and 15 minutes (11.9-21.7), respectively; median 3D LA volume was 165 mL (142-199).In 75 patients (42 index, 33 repeat procedures), pulmonary veins were targeted, and first-pass isolation was achieved in all using PFA only (median ablation 25 minutes [16-34]). Additional LA lines were applied in 87 of 102 (85%): anterior (34, 25 of 34 [73%] PFA + RFA), mitral isthmus (27, 18 of 27 [67%] PFA + RFA; 5 of 27 [18%] with PFA in the coronary sinus), posterior box (45, PFA only), and roof (23, PFA only). All lines were bidirectionally blocked, and posterior boxes isolated. A cavotricuspid isthmus line was created in 36 of 102 (35%; 30 of 36 [83%] RFA only). Procedural complications occurred in 3 of 102 (2.9%). Conclusion: The large-footprint dual-energy catheter enables safe and effective PVI, repeat PVI, and creation of complex left and right atrial lesion sets.