Peak frequency analysis of the straight-shaped pulsed field ablation catheter during cavotricuspid isthmus ablation

Figures

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  Figure 1. Electrical findings in case 1. A: AF was directly converted to sustained atrial tachycardia with a cycle length of 203 ms. B: High-density mapping of the right atrium revealed the tachycardia as AFL. After the second PFA application, the atrial activation sequence of atrial tachycardia with prolongation of cycle length (212 ms) was changed. C: Entrainment pacing of 200 ms from the lateral of the left atrium reveals the tachycardia as PMAT. AF = atrial fibrillation; AFL = atrial flutter; AT = atrial tachycardia; CS = coronary sinus; IFN = inferior; PFA = pulsed field ablation; PMAT = perimitral atrial tachycardia; RA = right atrium; SEP = septal

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  Figure 2. Peak frequency during cavotricuspid isthmus (CTI) ablation using the straight-shaped PFA catheter. CTI ablation was performed by deploying a straight-shaped PulseSelect PFA loop catheter halfway through a deflectable sheath. After the second application, the AFL converted to PMAT, and a bonus application was delivered to CTI. Fluoroscopy showed that the PFA catheter was positioned above the coronary sinus catheter. Peak frequencies were relatively high (>150 Hz), but those at the mid-CTI were relatively low (<150 Hz) on the OT near-field detection algorithm (Abbott Laboratories, Chicago, IL). AFL = atrial flutter; AT = atrial tachycardia; CS = coronary sinus; IFN = inferior; LAO = left anterior oblique; OT = omnipolar technology; PFA = pulsed field ablation; PMAT = perimitral atrial tachycardia; RA = right atrium; RAinf = inferior of right atrium; RAO = right anterior oblique; SEP = septal.

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  Figure 3. Recurrent AFL. High-density mapping of the right atrium (Advisor HD Grid Mapping Catheter) revealed a small conduction gap in the CTI block line. RF ablation by TactiFlex ablation loop catheter (Abbott Laboratories) at this site terminated the tachycardia. Retrospective analysis of pre-PFA electrograms showed low peak frequencies (<150 Hz) at the site of incomplete conduction block. AFL = atrial flutter; CS = coronary sinus; CTI = cavotricuspid isthmus; IFN = inferior; LAO = left anterior oblique; PFA = pulsed field ablation; RA = right atrium; RAinf = inferior of right atrium; RAO = right anterior oblique; SEP = septal.

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  Figure 4. A case that achieved complete cavotricuspid isthmus (CTI) block line. AFL terminated with a single application. Two bonus applications were delivered. Analysis of pre-PFA electrograms showed consistently high peak frequencies (>150 Hz) on the first application. AFL = atrial flutter; AT = atrial tachycardia; CS = coronary sinus; IFN = inferior; LAO = left anterior oblique; PFA = pulsed field ablation; PMAT = perimitral atrial tachycardia; RA = right atrium; RAinf = inferior of right atrium; RAO = right anterior oblique; SEP = septal.

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  Figure 5. Peak frequency maps of preapplication PFA potentials with the cutoff value of 150 Hz and 200 Hz during CTI ablation. Peak frequencies with a cutoff value of 150 Hz appropriately classify adequately contacted sites as suboptimal. CTI = cavotricuspid isthmus; IFN = inferior; PFA = pulsed field ablation.