Procedural characteristics of left atrial ablation procedures using a novel lattice-tip catheter

Abstract Background An innovative mapping and ablation large focal tip catheter that can toggle between pulsed field ablation (PFA) and radiofrequency (RF) integrated into a novel 3D mapping-platform has been introduced. So far, details on procedural characteristics are limited. Methods All consecutive patients undergoing left atrial (LA) ablation procedures for atrial fibrillation or atrial tachycardias with the new system were analyzed. All patients provided written informed consent and were enrolled in our prospective TRUST Registry. Results A total of 63 patients were enrolled, 39/63 (61.9%) underwent index pulmonary vein isolation (PVI) and 24/63 (38%) repeat procedures. Total mapping time was 23.3 ± 8.9 minutes (min, mean ± SD), recorded electrograms 4046 ± 1246, LA volume 169 ± 44 ml. In 51/63 (81%) patients, including 39 index PVI and 12 repeat procedures, complete PVI was achieved with first pass isolation using PFA only. Ablation time was 17.7 ± 6.9 min with 43.4 ± 10.5 PF applications for lateral PVs and 15.6 ± 7.4 min and 41.7 ± 11.2 PF applications for septal PVs. In 48/63 (76%) patients, additional LA linear lesion sets were performed: 25 anterior lines (all blocked, 8/25 (32%) RF only, 17/25 (68%) PFA and RF, mean ablation time 8.3 ± 6.2 min), 9 mitral isthmus lines (all blocked, 4/9 (44%) RF only, 5/9 (56%) PFA and RF, 2/9 (22%) additionally PFA applied within the coronary sinus, mean ablation time 17 ± 16.6 min), 25 posterior box lesions (all isolated, all PFA only, mean ablation time 5.5 ± 3.9 min), 17 roof lines (all blocked, all PFA only, mean ablation time 2.6 ± 2.2 min). In 23/63 (37%) patients a cavotricuspid isthmus line was performed and blocked in all with RF only with a mean ablation time of 4.6 ± 6.5 min. In 1/63 (2%) patients RF applications were additionally applied in the right atrium to treat a focal AT. Ablation-related complications occurred in 1/63 (1.6%) patients (1 cardiac tamponade). Conclusion The novel focal RF/PF lattice-tip catheter enables rapid high-density left atrial mapping and effective and safe PVI, Re-PVI and creation of additional left arial lesion sets.