Background
A novel focal catheter delivering exclusively pulsed field ablation (PFA) energy has recently been introduced for the treatment of atrial tachyarrhythmias. While initial experience has focused mainly on cavotricuspid isthmus (CTI) ablation, data regarding left atrial linear ablation remain still limited.
Objective
To evaluate the acute efficacy and safety of a novel focal bipolar PFA catheter for left atrial linear lesion creation during redo atrial fibrillation (AF) procedures.
Method
In this prospective single-center study, 46 consecutive patients undergoing repeat ablation for recurrent AF or atrial tachycardia following previous pulmonary vein isolation (PVI) were enrolled. Acute procedural outcomes and safety data were analyzed.
Results
A total of 75 left atrial linear lesions were performed, including 25 roof lines, 31 anterior lines, 14 posterior mitral isthmus lines, and 5 posterior wall isolations. Acute bidirectional block was achieved in 100% of roof lines, 90% of anterior lines, and 100% of posterior mitral isthmus lines and posterior wall isolations. Among 183 remapped pulmonary veins, 31 (16.9%) showed reconnection and were successfully re-isolated in all cases. Additional CTI ablation with successful bidirectional block was performed in 18 patients. Mean procedure time was 65 ± 18 minutes and mean fluoroscopy time was 8.5 ± 3.0 minutes. One pericardial effusion related to transseptal puncture occurred. No coronary spasm or other complications were observed.
Conclusions
Left atrial linear ablation using a novel focal bipolar PFA catheter is associated with high rates of acute procedural success and a favorable safety profile. The catheter enabled effective creation of complex left atrial linear lesions, repeat PVI, and adjunctive CTI ablation during redo AF procedures. These findings support the expanding role of focal PFA technology beyond pulmonary vein isolation.
