Feasibility of slow pathway modulation using a dual-energy lattice-tip catheter

Abstract Background Pulsed field ablation (PFA) is increasingly used for atrial fibrillation (AF) ablation. Although spontaneous atrioventricular nodal reentrant tachycardia (AVNRT) during AF ablation is reported, evidence regarding its management and ablation with PFA system are scarce. Purpose To evaluate the feasibility and safety of AVNRT ablation performed with a lattice-tip, dual-energy catheter. Methods We analyzed data from consecutive patients who underwent AF ablation with an 9-mm lattice tip, dual-energy catheter between November 2024 and October 2025. Patients in whom AVNRT occurred during PFA and subsequently ablated with lattice-tip catheter were included. His-cloud was acquired on the 3-dimensional electroanatomical map. Radiofrequency (RF) energy was delivered in temperature-controlled mode on slow pathway region, at the base of Koch’s triangle. The primary efficacy endpoint was post-ablation non-inducibility of AVNRT and/or absence of dual-nodal physiology, assessed with programmed electrical stimulation after 20 minutes of waiting-time. The primary safety endpoint was the occurrence of permanent atrio-ventricular block. Follow up was conducted with Holter monitor and office visit. Results A total of 12 patients were included mean age 63±9 years; 5 (41,7%) female. The primary efficacy endpoint was achieved in all patients (100%). The mean number of lesions required for slow pathway modulation was 2±1.3. Slow junctional rhythm occurred in 8 (66,6%) procedures. No transient atrio-ventricular block occurred in our cohort. At a mean follow up of 132±26 days no supraventricular tachycardia was reported. Conclusion Slow pathway modulation using RF with a lattice-tip catheter is feasible and safe, with high acute success.Slow pathway modulation