Assessment of incomplete lesions using 3-dimensional mapping following pentaspline pulsed field ablation for atrial fibrillation

Figures

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  Figure 1. Distribution and touch-up requirements of incomplete lesion formation following pentaspline pulsed field ablation. A: Distribution of complete and incomplete lesion formation in patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI) alone (n = 50). Incomplete lesions, confirmed by electrogram-based 3D mapping, were detected in 16% (n = 8). B: Number of iterative application–remapping cycles required to achieve complete lesion formation among patients with incomplete lesions in patients undergoing PVI alone. Among 8 patients with incomplete lesions, 4 required 1 cycle, 3 required 2 cycles, and 1 patient required 3 cycles. C: Distribution of complete and incomplete lesion formation in patients with persistent AF undergoing PVI plus posterior wall isolation (PWI) (n = 50). Incomplete lesions, confirmed by 3D mapping, were observed in 48% (n = 24). D: Number of iterative application–remapping cycles required in patients undergoing PVI plus PWI. Among 24 patients with incomplete lesions, 19 required 1 cycle, 3 required 2 cycles, and 2 patients required 3 cycles.

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  Figure 2. Representative cases of incomplete lesion formation following pentaspline pulsed field ablation under guidance primarily based on fluoroscopy for atrial fibrillation. Three-dimensional voltage maps of the left atrium generated using the CARTO 3 system are shown for representative cases of incomplete lesion formation. Low-voltage (ablated) areas are depicted in red (bipolar voltage <0.05 mV), whereas preserved or viable tissue is shown in purple (bipolar voltage >0.5 mV), with transitional areas represented in green and yellow (bipolar voltage between 0.05 and 0.5 mV). A–D: Each panel illustrates a case of incomplete pulmonary vein (PV) isolation (PVI) or posterior wall isolation (PWI), with pre– (left) and post–touch-up (right) voltage maps presented for direct comparison. A: Incomplete lesions (yellow arrowheads) at the left and right inferior PVs following PVI in a patient with paroxysmal AF. B: Incomplete lesion (yellow arrowhead) at the carina between the right superior and inferior PVs after initial ablation a patient with paroxysmal AF. C: Incomplete lesions (yellow arrowheads) at the roof and inferior regions adjacent to the right PVs following PWI in a patient with…

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  Figure 3. Temporal trend in incomplete lesion detection analyzed by sequential case quartiles. Bar graphs illustrate the number of patients with incomplete lesion formation detected by 3-dimensional electroanatomical mapping after pulsed field ablation (PFA), grouped by procedural quartiles (25 patients per group). A: Overall cohort analysis (n = 100). The number of patients with incomplete lesions was 8, 7, 5, and 12 across the first to fourth quartiles, respectively. No statistically significant trend was observed across quartiles (P = .189). B: Subgroup analysis of patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI) alone. The number of patients with incomplete lesions remained consistently low across quartiles (1, 2, 2, and 3 cases, respectively; P = .289). C: Subgroup analysis of patients with persistent AF undergoing PVI plus posterior wall isolation. Although a numerical increase was observed in the final quartile, no significant trend was detected (7, 5, 3, and 9 cases, respectively; P = .179). These findings suggest that the incidence of incomplete lesion formation did not decline over time in either subgroup, indicating that operator…