Key result
Validation of pulmonary vein isolation with electroanatomical mapping did not significantly reduce arrhythmia recurrence compared to fluoroscopy alone (20% vs. 16.1%; p=0.72).
Why the study?
The authors aimed to assess whether adding electroanatomical mapping to confirm pulmonary vein isolation during pulsed field ablation increases procedural efficacy regarding arrhythmia recurrences.
Does the addition of electroanatomical mapping (EAM) to fluoroscopy-guided pulsed field ablation (PFA) reduce arrhythmia recurrence in patients with atrial fibrillation undergoing first-time pulmonary vein isolation?
RCT (n=51)
Does the addition of electroanatomical mapping (EAM) to fluoroscopy-guided pulsed field ablation (PFA) reduce arrhythmia recurrence in patients with atrial fibrillation undergoing first-time pulmonary vein isolation?
The addition of electroanatomical mapping to fluoroscopy-guided pulsed field ablation for first-time pulmonary vein isolation increases procedure time without significantly reducing arrhythmia recurrence.
Introduction Pulsed field ablation (PFA) is a form of nonthermal energy that has been recently introduced for pulmonary vein isolation (PVI). A multi‐electrode pentaspline catheter for delivery of PFA guided by fluoroscopy has become widely available for clinical use. Methods and Results In this study, we aimed to assess whether the addition of electroanatomical mapping (EAM) for confirmation of PVI in the acute phase can increase the efficacy of the procedure in terms of arrhythmia recurrences. A total of 51 patients with atrial fibrillation (AF) scheduled for first time PVI were included in the study. Participants were assigned to receive PVI using fluoroscopy guidance only (Fluoro‐only group: 31 patients) or additional validation with EAM (EAM group: 20 patients). Endpoints included arrhythmia recurrence and procedural characteristics. During a 11.2 ± 1.3 months follow‐up period, arrhythmia recurrences did not statistically differ between groups (16.1% vs. 20%, p .72). Procedure time was longer in the EAM group (86.5 ± 11.4 vs. 78.4 ± 9.3 min, p .008). EAM revealed 5 nonisolated PVs that were re‐ablated using the same catheter. Four patients of the cohort underwent a redo‐procedure during the follow‐up period. In all 4 cases, at least one reconnected PV was identified. Conclusion In a cohort of patients with AF undergoing first time PVI using a pentaspline PFA catheter, PVI validation with EAM did not lead to significantly different arrhythmia recurrence rates compared to PVI without EAM. In the acute phase, the rate of nonisolated PVs was low.
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Kariki et al. (2024) conducted an RCT in Atrial fibrillation (n=51). Electroanatomical mapping (EAM) validation vs. Fluoroscopy guidance only was evaluated on Arrhythmia recurrence (p=0.72). Validation of pulmonary vein isolation with electroanatomical mapping did not significantly reduce arrhythmia recurrence compared to fluoroscopy alone (20% vs. 16.1%; p=0.72).
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