Unintended Right Atrial Lesions After Monopolar Biphasic Lattice-tip Pulsed-Field Ablation: A Case Series

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Atrial Fibrillation (Persistent and Paroxysmal) (n=4). Intervention: Monopolar biphasic lattice-tip pulsed-field ablation (Sphere-9). Primary outcome: Unintended right atrial lesion formation identified by post-procedural electroanatomic mapping.

Q: What does this research mean for the field?

Monopolar biphasic lattice-tip pulsed-field ablation can cause unintended lesions in adjacent right atrial structures when anatomical proximity is close or catheter stability is compromised. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jun Hirokami; 廣島 謙一; Michio Nagashima; Masato Fukunaga; Kengo Korai; Kenji Andò

doi:10.1093/ehjcr/ytag730

September 29, 2026European Heart Journal - Case ReportsOpen Access

Unintended Right Atrial Lesions After Monopolar Biphasic Lattice-tip Pulsed-Field Ablation: A Case Series

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Key result

Lattice-tip pulsed-field ablation causes unintended right atrial lesions in ~100% of cases during PVI.

n=4

Why the study?

The impact of monopolar biphasic lattice-tip pulsed-field ablation on adjacent right atrial structures remains poorly characterized.

Does monopolar biphasic lattice-tip pulsed-field ablation create unintended right atrial lesions during pulmonary vein isolation for atrial fibrillation?

Key Points

To characterize unintended right atrial lesion formation and evaluate contributing factors following pulmonary vein isolation using a monopolar biphasic lattice-tip pulsed-field ablation catheter.
Evaluated consecutive patients (N=4) undergoing pulmonary vein isolation for atrial fibrillation with a monopolar biphasic lattice-tip catheter (Sphere-9).
Performed procedures under deep sedation using propofol, thiopental, and pentazocine, with three-dimensional electroanatomic mapping of both atria conducted in sinus rhythm before and after ablation.
Unintended right atrial lesions involving the posterior right atrium, interatrial septum, or superior vena cava were identified in all 4 patients despite successful pulmonary vein isolation.
Lesions formed in regions where the distance between the right pulmonary veins and adjacent right atrial structures was approximately 2 mm or less in 3 patients.
Coughing under deep sedation caused catheter tip dislodgement and map shifts in 2 patients, contributing to broader interatrial septal lesion formation.

Study Design

Type

Case Report (n=4)

Multicenter

No

Structured PICO

Does monopolar biphasic lattice-tip pulsed-field ablation create unintended right atrial lesions during pulmonary vein isolation for atrial fibrillation?

P

Population

4 patients with symptomatic atrial fibrillation (mean age 73.5 years, 50% female) undergoing pulmonary vein isolation using a monopolar biphasic lattice-tip pulsed-field ablation catheter.

I

Intervention

Pulmonary vein isolation using a monopolar biphasic lattice-tip pulsed-field ablation (PFA) catheter (Sphere-9).

O

Outcome

Unintended right atrial lesions involving the posterior right atrium, interatrial septum, or superior vena cava, as identified by post-procedural electroanatomic mapping.safety

Monopolar biphasic lattice-tip pulsed-field ablation may create unintended right atrial lesions when the anatomical distance between right pulmonary veins and right atrial structures is short or catheter stability is compromised.

Limitations

Small sample size (4 patients from a single center)
Lesion durability not assessed
Clinical significance of lesions remains uncertain
Findings specific to one monopolar biphasic lattice-tip catheter
CT anatomical measurements performed by a single operator
Intracardiac echocardiography was not systematically used
Single center
Small sample size (four patients)
Lesion durability not assessed due to lack of repeat mapping
Uncertain clinical significance of unintended lesions on atrial arrhythmia recurrence and long-term conduction
Findings specific to monopolar biphasic lattice-tip catheter and may not generalize to other PFA technologies
CT-based anatomical measurements performed by a single operator without reproducibility assessment
Lack of systematic intracardiac echocardiography to confirm catheter-tissue contact and anatomical location

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Alerts to off-target right atrial lesions with monopolar biphasic lattice-tip PFA in close anatomy or instability; leaves open incidence and mitigation in larger studies.

Abstract

Structured Abstract Background Monopolar biphasic pulsed-field ablation (PFA) delivered by a lattice-tip catheter may create deeper lesions than conventional bipolar systems. The impact on adjacent right atrial structures remains poorly characterized. Case summary We report four patients undergoing pulmonary vein isolation using a lattice-tip PFA catheter. Post-procedural electroanatomic mapping revealed unintended right atrial lesions involving the posterior right atrium, interatrial septum, or superior vena cava. In patients with short anatomical distances between right pulmonary veins and adjacent right atrial structures, lesions developed despite apparently successful pulmonary vein isolation. Catheter instability related to coughing under deep sedation appeared to contribute to broader lesion formation in two cases. Conclusion These cases suggest that monopolar biphasic lattice-tip PFA may create unintended lesions in adjacent right atrial tissue when anatomical proximity is short or catheter stability is compromised. Awareness of these mechanisms may help optimize procedural safety and lesion delivery.

Discussion

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Cite This Study

Hirokami et al. (2026) conducted a case report in Atrial Fibrillation (Persistent and Paroxysmal) (n=4). Monopolar biphasic lattice-tip pulsed-field ablation (Sphere-9) was evaluated on Unintended right atrial lesion formation identified by post-procedural electroanatomic mapping. Monopolar biphasic lattice-tip pulsed-field ablation created unintended right atrial lesions in all 4 patients due to short anatomical proximity and catheter instability.

synapsesocial.com/papers/6abe3592bdd7597321d9a486 https://doi.org/10.1093/ehjcr/ytag730

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Unintended Right Atrial Lesions After Monopolar Biphasic Lattice-tip Pulsed-Field Ablation: A Case Series

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Unintended Right Atrial Lesions After Monopolar Biphasic Lattice-tip Pulsed-Field Ablation: A Case Series

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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