BACKGROUND: Single-shot pulsed-field ablation (PFA) catheters show promising safety and efficacy for achieving pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, additional PFA applications are sometimes required after standard PFA delivery to achieve PVI. OBJECTIVE: This study aimed to evaluate the real-world frequency and location of acute residual pulmonary vein (PV) connections using 3-dimensional electroanatomic mapping (3D-EAM) during index PFA. METHODS: Patients undergoing index PVI with a single-shot PFA catheter and receiving postablation 3D-EAM were prospectively studied. First-pass isolation (FPI) rates and distribution of residual PV connections were assessed. RESULTS: A total of 535 patients from 48 international centers (89 operators) were included (paroxysmal AF 375; persistent AF 160). Mean procedure time was 75.9 ± 31.9 minutes, and mapping time was 8.4 ± 5.2 minutes. Ablation was performed with a pentaspline, variable conformation PFA catheter in 72.7% of cases and a fixed-loop PFA catheter in 27.3%. Bilateral FPI was achieved in 75.1% of patients (paroxysmal AF 77.1% vs persistent AF 70.6%; P = .126). The individual PV FPI rate was 92.7% (1834 of 1978 PVs). Excluding common PVs, residual PV connections were more frequent in superior PVs (superior 8.9% vs inferior 3.8%; P < .001), specifically in the left superior PV (10.1%). Predictors of FPI included standard 4-vein anatomy (odds ratio, 1.83; 95% confidence interval, 1.09-3.07; P = .021) and the pentaspline catheter (odds ratio, 3.53; 95% confidence interval, 1.81-6.87; P < .001). CONCLUSION: Using 3D-EAM, an acute residual connection of at least 1 PV was observed in a quarter of patients after standard PFA delivery and was most common in the left superior PV. Potential mechanisms include reversible electroporation, highlighting the potential need for additional lesions and the value of a mandatory post-PFA "waiting period."

Abbott Medical St Paul Minnesota

Capio Arytmi Center Stockholm Stockholm Sweden

Clinic for Electrophysiology Heart and Diabetes Center North Rhine Westphalia Bad Oeynhausen Germany

Department of Cardiology St Mark's Hospital HCA Healthcare Salt Lake City Utah

Department of Electrophysiology Community Heart and Vascular Indianapolis Indiana

Division of Cardiology Swedish Hospital Endeavour Health Chicago Illinois

Heart Rhythm Institute Oklahoma Heart Hospital Oklahoma City Oklahoma

Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital Liverpool United Kingdom; Department of Cardiology Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool United Kingdom

Nemocnice Ceske Budejovice and Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Czech Republic

Citace poskytuje Crossref.org

Acute durability of cavotricuspid isthmus block after pulsed electric field ablation: randomized comparison of two pentaspline catheter configurations (SECTION trial)