Pentaspline vs variable-loop circular catheter using pulsed field ablation for atrial fibrillation transcatheter ablation

Abstract Background Pulsed field ablation (PFA) has recently been introduced into clinical practice for atrial fibrillation (AF) catheter ablation. However, limited data are available comparing different catheter technologies in the literature. Objective The aim of this study was to compare two different PFA catheter technologies, with and without the use of an electroanatomic mapping system, for transcatheter ablation of AF. Methods We conducted a retrospective, single-center observational study enrolling patients who underwent PFA catheter ablation for paroxysmal or persistent AF between August 2022 and December 2024. A total of 343 patients were included and divided into two groups: a multi-electrode pentaspline catheter (MP, n=279, 81%) and a variable-loop circular catheter combined with a 3D mapping system (VLCC, n=64, 19%). Comparisons between the two groups were performed both on the overall population and after propensity score matching based on major clinical covariates. All MP procedures were performed under general anesthesia, whereas some VLCC procedures were performed under deep sedation (Table 1), and some without ventilatory support. Intracardiac ultrasound was used in all VLCC procedures according to the center’s workflow. Results Table 1 summarizes the main clinical, arrhythmic, and procedural characteristics. Pulmonary vein isolation was successfully achieved in all patients. Additional lesions were delivered in some cases, mostly at the posterior wall. The VLCC group showed shorter fluoroscopy times but longer left atrial dwell times, with no statistically significant difference in total procedural duration, despite a higher rate of extra-PVI lesions in the MP group (Table 1). Periprocedural complication rates did not differ significantly between groups. Follow-up data showed no significant differences in arrhythmia recurrence between the two groups (Figure 2). Conclusion The VLCC catheter was associated with reduced fluoroscopic exposure without a procedural time advantage, largely due to longer left atrial dwell times. However, VLCC procedures were better tolerated than MP, which required anesthesia support. No significant differences in efficacy were observed at mid-term follow-up. Long-term follow-up data are still lacking. These findings suggest potential personalized applications: VLCC may be preferable in younger patients to minimize fluoroscopic exposure, whereas MP may be more suitable for older or frailer patients due to shorter procedural times.