Background:
A large footprint mapping and ablation catheter that can toggle between pulsed field ablation (PFA) and radiofrequency (RF) integrated into a novel 3D mapping-platform has been introduced. Real-world data on pulmonary vein isolation (PVI) and complex atrial ablation procedures with this system remain scarce.
Methods:
Ablation procedures for atrial fibrillation or atrial tachycardias (AT) in consecutive patients enrolled in the prospective TRUST Registry (ClinicalTrials.gov ID: NCT05521451) were analyzed.
Results:
A total of 102 patients, 37/102 (36%) women, median age 68 (60–75) years, median left ventricular ejection fraction 60% (53–60)) were enrolled. Of these, 42 patients (41%) underwent index PVI, 57 patients (56%) repeat PVI, and 3 patients (3%) primary left-sided AT ablation. Among the 60 patients (59%) with a history of previous ablation, 37/60 (62%) had undergone one prior procedure, 12/60 (20%) had undergone two prior procedures, and 11/60 (18%) more than two prior procedures. Median procedure time was 91 (78–114) min, mapping time 15 min (11.9–21.7) and 3D LA volume 165 (142–199) ml. The cumulative ablation time per patient was 5.3 (4–7) min, with a median of 78 lesions (56–106) applied. In 75 patients, including 42 index PVI and 33 repeat procedures, PVs were targeted, and first pass PV isolation was achieved in all using PFA only (median ablation time 25 min (16–34)). In 87/102 (85%) patients, additional LA linear lesion sets were applied, using a combination of RF and PFA. All lines were bidirectionally blocked, all posterior boxes electrically isolated. In 36/102 (35%) patients, a cavo-tricuspid isthmus line was created (all blocked, 30/36 (83%) using RF only). Major procedural complications occurred in 3/102 (2.9%) patients.
Conclusion:
The novel, large footprint dual-energy catheter enables safe and effective PVI, Re-PVI, and creation of additional complex right and left atrial lesion sets.
