Characterization of circumferential antral pulmonary vein isolation areas resulting from pulsed-field catheter ablation. Issue 1 (19th July 2022)

• Record Type: Journal Article
• Authors: Bohnen, Marius; Weber, Reinhold; Minners, Jan; Jadidi, Amir; Eichenlaub, Martin; Neumann, Franz-Josef; Arentz, Thomas; Lehrmann, Heiko
• Is Part Of: Europace. Volume 25:Issue 1(2023)
• Page Start: 65
• Page End: 73
• Publication Date: 2022-07-19
• Subjects: Pulmonary vein isolation -- Pulsed-field ablation -- Antral -- Circumferential -- Isolation area -- Catheter ablation; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac111
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: The cornerstone of pulmonary vein (PV) isolation (PVI) is a wide-area circumferential ablation (WACA) resulting in an antral PVI area. Pulsed-field ablation (PFA) is a new nonthermal 'single-shot' PVI technique resulting in well-characterized posterior isolation areas. However, information on circumferential PVI area is lacking. Thus, we sought to characterize the circumferential antral PVI areas after PFA-PVI. Methods and results: Atrial fibrillation (AF) patients underwent fluoroscopy-guided PVI with a pentaspline PFA catheter. Ultra-high-density voltage maps using a 20-polar circular mapping catheter were created before and immediately after PVI to identify and quantify (i) insufficient isolation areas per antral PV segment (10-segment model) and (ii) enlarged left atrial (LA) isolation areas (beyond the antral PV segments) per LA region (8-region model). The PFA-PVI with pre- (5469 ± 1822 points) and post-mapping (6809 ± 2769 points) was performed in 40 consecutive patients [age 62 ± 6 years, 25/40 (62.5%) paroxysmal AF]. Insufficient isolation areas were located most frequently in the anterior antral PV segments of the left PVs (62.5–77.5% of patients) with the largest extent (median ≥0.4 cm 2 ) located in the same segments (segments 2/5/8). Enlarged LA isolation areas were located most frequently and most extensively on the posterior wall and roof region (89.5–100% of patients; median 1.1–2.7 cm 2 per region). Conclusion: Fluoroscopy-guided PFA-PVI frequently results in insufficient isolation areas in the left anterior antral PV segments and enlarged LA isolation areas on the posterior wall/roof, which both may be extensive. To optimize the procedure, full integration of PFA catheter visualization into three-dimensional-mapping systems is needed.