https://doi.org/10.1007/s00392-025-02625-4
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 2Universitätsklinik Schleswig-Holstein, Campus Kiel Klinik für Kardiologie und internistische Intenisvmedizin Kiel, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 4Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
A novel lattice-tip combined mapping and ablation catheter, capable of pulsed-field (PFA) and conventional radiofrequency (RF) ablation and fully integrated into a novel mapping and ablation platform, has been introduced. Information on long-term outcomes for a range of clinically used left and right atrial ablation targets is not yet fully available.
Methods
Consecutive patients undergoing first-time AF ablation using the new system at our center and with one-year follow-up were collected and analysed. AF ablation consisted of PFA-based pulmonary vein isolation and, based at the clinician's discretion, additional linear lesions (RF or PFA). All patients provided written informed consent and were enrolled in our prospective TRUST Registry (ClinicalTrials.gov Identifier: NCT05521451).
Results
A total of 32 patients were analysed (11/32 (34%) women, median age 67.5 years (61.2–74.5), 16/32 (50%) persistent AF (Pers-AF), median left ventricular ejection fraction (LVEF) 60% (50.7–60)). Acute PVI with PFA only was achieved in 32/32 (100%) PVs with first pass isolation in 125/125 (100%) PVs. Median mapping time was 22.5 (16–28.2) minutes. Additional left atrial linear lesions were delivered in 19/32 (59%) patients, including 6 anterior lines (RF+PFA), 3 mitral isthmus lines (2/3 (66.6%) RF and 1/3 (33.3%) RF+PFA), 11 roof lines (PFA), and 1 posterior box (PFA). In 7/32 (21.9%) patients, cavo-tricuspid isthmus ablation was performed after documentation of typical atrial flutter. All the linear lesion sets were bidirectionally blocked at the end of the procedure. Mean procedure and fluoroscopy times were 100.8 ± 25.4 and 8.6 ± 3.8 minutes, respectively. Mean dose area product was 518.2 ± 433.9 cGycm2. Cumulative median ablation time was 5.85 (4.88–7.06) minutes and median number of lesions was 93.5 (78.5–105.2). Ablation-related complications occurred in 1/32 (3%) patients (1 cardiac tamponade). AF free survival after a median FU of 341 (236–360) days was 82.9% for paroxysmal AF (PAF) and 67.5% for Pers-AF (p value = 0.62).
Conclusion
Large focal-tip catheter-based ablation for AF appears safe and effective for a range of left and right atrial ablation targets with good rhythm outcomes at one-year follow-up.