Feasibility and acute results of a circular over-the-wire pulse field ablation catheter for pulmonary vein isolation and linear ablation lesions

Purpose Pulse field ablation (PFA) is an ablation modality based on irreversible electroporation and is typically used to isolate the pulmonary veins in the treatment of atrial fibrillation (AF). The safety and efficacy of PulseSelect PFA for other linear lesions is less well substantiated in the literature. We describe a novel use of this circular, over-the-wire PFA catheter for the ablation of the cavotricuspid isthmus (CTI), mitral isthmus (MI), and posterior wall isolation (PWI) as part of ablation for AF. Methods Data was collected prospectively on consecutive patients undergoing AF ablation using the PulseSelect catheter. CTI, MI, and PWI ablation was performed as based on patient factors and if there was documented atrial flutter. Acute bidirectional block was tested for both the CTI and MI, and isolation of the posterior wall was demonstrated during remapping. Continuous periprocedural ECG monitoring was performed. Patients underwent clinical follow-up at 3, 6, and 12 months. Results and Discussion 62 patients were included in this dataset. 61 patients had PVI, 52 patients had CTI ablation, 36 had MI ablation, and 38 had PWI. Successful PVI was observed in all patients where the veins were targeted. Acute CTI block was observed in 98% of cases. MI block was achieved in 94.4% of patients. Mean followup was 9.7 Months. Freedom from recurrence of AT/AF was observed in 85.5% patients. Recurrence was AF (8.1%), typical atrial flutter (1.6%), and atypical atrial flutter/atrial tachycardia (4.8%). A total of 857 lesions were delivered in close proximity to the right and left coronaries without prophylactic nitrates and no coronary spasm was observed. Conclusions PFA using the PulseSelect catheter is feasible and acutely successful when targeting both the pulmonary veins and the CTI, MI and PWI. There were no major safety events observed directly relating to the catheter, and in particular no coronary spasm was observed. Longterm durability of the lesion sets remains unknown. Capsule Summary The circular PFA PulseSelect catheter can be used to create linear atrial ablation lesions using the multiple techniques described. These data suggest it is safe when being used close to coronary arteries and no coronary spasm was observed. Acute success rates are encouraging but longer term followup is required.