Clin Res Cardiol (2025). DOI 10.1007/s00392-025-02737-x
1CCB im AGAPLESION MARKUS KRANKENHAUS Kardiologie Frankfurt am Main, Deutschland; 2Agaplesion Markus Krankenhaus Medizinische Klinik III - CCB Frankfurt am Main, Deutschland
Background:
The 9-mm nitinol lattice-tip catheter allows for focal radio frequency (RF) and pulsed field ablation within a single catheter. While initial procedural success rates are high, data on the durability of linear lesions, particularly in re-do ablation procedures, remain limited.
Objective:
To evaluate the durability of linear lesion block in patients undergoing repeat ablation procedures after initial treatment with a lattice-tip ablation catheter.
Methods:
Patients undergoing re-do ablation after an index procedure with the lattice-tip catheter were retrospectively analyzed. At the time of the initial procedure, acute conduction block was successfully achieved across all linear lesions without difficulty. During repeat procedures, all previously created linear lesions—such as anterior lines, mitral isthmus or roof lines—were systematically evaluated for bidirectional block. Furthermore, in patients who underwent left atrial appendage (LAA) isolation with the lattice-tip catheter and subsequently received left atrial appendage closure (LAAC) after 6 weeks, the persistence of LAA isolation was assessed using a Lasso catheter. Sustained conduction block across the linear lesions was assumed in cases of persistent LAA isolation.
Results:
A total of 15 patients (median age 72 years [IQR 62–76]; 53% female) were included in the analysis. Of these, 6 underwent repeat procedures due to arrhythmia recurrence and 9 were scheduled for LAAC. In total, 36 linear lesions were created. At the time of the scheduled LAAC procedure, durable isolation of the LAA was confirmed in 6 of 9 patients (66.7%).
In the re-do group, 6 out of 12 (50%) linear lesions showed durable conduction block. While all roof lines (4/4) remained persistently blocked, both mitral isthmus lines were reconnected. Anterior lines showed durable conduction block in 2 of 6 cases (33.3%).
Conclusion:
Linear lesions created with the lattice-tip catheter demonstrated a moderate rate of durable conduction block in repeat procedures. Roof lines exhibited the highest durability, whereas mitral isthmus and anterior lines showed substantially lower rates of persistent block. These findings support the general feasibility of lesion formation with a dual-energy ablation catheter, while also highlighting the need for optimized energy source selection and delivery strategies depending on the lesion location.