Key result
Integrated FARAVIEW mapping in pulsed-field ablation showed comparable AF recurrence requiring repeat ablation vs fluoro-only (27.4% vs 35.1%; OR 0.70, 95% CI 0.39–1.25; p=0.23).
Why the study?
Pulsed field ablation with the FARAPULSE system is an established strategy for PVI in AF, but whether integrated electro-anatomical mapping with the FARAVIEW system improves clinical outcomes compared with high-density mapping or fluoroscopy-only workflows remained uncertain.
Does integrated electro-anatomical mapping with the FARAVIEW system reduce clinical atrial fibrillation recurrence leading to repeat ablation compared with high-density mapping or fluoroscopy-only workflows in patients undergoing pulsed field ablation for atrial fibrillation?
Cohort (n=921)
No
Does integrated electro-anatomical mapping with the FARAVIEW system reduce clinical atrial fibrillation recurrence leading to repeat ablation compared with high-density mapping or fluoroscopy-only workflows in patients undergoing pulsed field ablation for atrial fibrillation?
In patients undergoing pulsed field ablation for atrial fibrillation, an integrated mapping-ablation workflow achieved comparable arrhythmia recurrence and pulmonary vein reconnection rates to high-density mapping and fluoroscopy-only workflows while significantly reducing fluoroscopy time and radiation exposure.
Answers are grounded in this paper and cite their sources.
Comparable repeat ablation rates with integrated mapping; leaves open whether fluoroscopy reduction improves outcomes in pulsed-field ablation.
Background Pulsed field ablation (PFA) with the FARAPULSE system is an established non-thermal strategy for pulmonary vein isolation (PVI) in atrial fibrillation (AF), supported by large registries and randomised trials. Whether integrated electro-anatomical mapping with the FARAVIEW system improves clinical outcomes compared with high-density (HD) mapping or fluoroscopy-only workflows remains uncertain. Purpose To compare AF recurrence, pulmonary vein (PV) reconnection and fluoroscopy exposure across three FARAPULSE PFA workflows: HD mapping, fluoroscopy-only, and integrated FARAVIEW. Methods We retrospectively analysed 921 consecutive patients undergoing FARAPULSE PFA-guided PVI for AF, assigned chronologically to three groups: HD Map (Group A, n=221), Fluoro-only (Group B, n=638) and FARAVIEW (Group C, n=62). All procedures used standardised PVI lesion sets; FARAVIEW enabled combined real-time mapping and ablation in a single catheter. The primary endpoint was clinical AF recurrence leading to repeat ablation (Re-Do) during follow-up. Secondary endpoints included PV reconnection per initially isolated vein and fluoroscopy time. Differences in categorical outcomes were evaluated using Chi-square tests, with effect sizes quantified as Odds Ratios (OR) and 95% confidence intervals (CI). Results Re-Do procedures occurred in 71/221 (32.1%) patients in Group A, 224/638 (35.1%) in Group B and 17/62 (27.4%) in Group C (global p=0.39). Compared with Fluoro-only, the odds of recurrence were numerically lower with FARAVIEW (OR 0.70, 95% CI 0.39–1.25, p=0.23) and HD Map (OR 0.87, 95% CI 0.63–1.21, p=0.42), without statistically significant differences. Figure 1 illustrates the numerical reduction in AF recurrence odds with FARAVIEW compared with Fluoro-only, although confidence intervals cross unity. Among 3,644 initially isolated PVs, reconnection occurred in 56/884 (6.3%) veins in Group A, 192/2,552 (7.5%) in Group B and 12/208 (5.8%) in Group C (global p=0.36). As shown in Figure 2, clinical recurrence was numerically lowest with FARAVIEW and highest with Fluoro-only, while overall outcomes remained comparable, also FARAVIEW showed the lowest PV reconnection rates. Compared to Fluoro-only and HD mapping, FARAVIEW significantly minimized median fluoroscopy time (4.6 vs. 10.2 and 8.8 min, respectively; p < 0.001) as well as radiation dose (1222 vs. 2344 and 2043 cGycm²; p = 0.018). Conclusions In this single-centre three-phase experience, an integrated FARAVIEW mapping–ablation workflow achieved clinical and PV-level outcomes that were at least comparable (“non-inferior”) to established HD mapping and fluoroscopy-only FARAPULSE PFA workflows, while reducing fluoroscopy exposure. These findings support the use of integrated mapping technology to streamline PFA procedures without compromising efficacy, although larger cohorts are needed to confirm the observed favourable trends.
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Lippert et al. (2026) conducted a cohort in Atrial fibrillation (n=921). Integrated FARAVIEW electro-anatomical mapping and ablation workflow vs. Fluoroscopy-only workflow and high-density (HD) mapping workflow was evaluated on Clinical atrial fibrillation recurrence leading to repeat ablation (Re-Do) during follow-up (OR 0.70, 95% CI 0.39–1.25, p=0.23). Integrated FARAVIEW mapping in pulsed-field ablation showed comparable AF recurrence requiring repeat ablation vs fluoro-only (27.4% vs 35.1%; OR 0.70, 95% CI 0.39–1.25; p=0.23).
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