Comparison of Pentaspline Pulsed Field Ablation Catheter Mapping Modes to Assess Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

BACKGROUND: We assessed the electro-anatomic mapping (EAM) capabilities of a pulsed field ablation (PFA) system previously guided by fluoroscopy to assess acquisition modes, and effects of near and far-field signal. METHODS: After pulmonary vein isolation (PVI) proven by pacing to check entrance and exit block, EAM was performed in 2 modes with the Faraview system during CS pacing. Mode 1 utilized bipoles between electrode 3 of each adjacent catheter spline. Mode 2 utilized a pseudo-unipole between electrode 3 and a combination of electrodes 1, 2, and 4 on individual splines. Signals and voltage map demonstration of PVI were compared with pacing assessment. Two observers assessed the maps with a third observer to resolve discrepancies. RESULTS: Fifteen patients (87% male, aged 58 ± 9 years) had PVI then mapping with the Faraview system. Pacing confirmed isolation of all pulmonary veins. Bipolar mapping (mode 1) displayed multiple apparent PV signals: only 32/61 (52%) of veins appeared isolated. On pseudo-unipolar mapping 59/61 (97%) of veins appeared isolated. The majority of variance in assessment (70.4%) was explainable by the mapping method with minimal variance attributed to observer. CONCLUSIONS: Pseudo-unipolar EAM Faraview mode appears the most accurate for assessment post-PVI compared with bipolar mode.