Location of conduction gaps in reconnected pulmonary veins after ablation with the pentaspline pulsed field catheter

Abstract Background Pulsed field ablation (PFA) is increasingly gaining popularity for cardiac ablation. The 31/35 mm pentaspline PFA catheter is a single-shot device for pulmonary vein isolation (PVI). Remapping data of patients undergoing repeat procedures for recurrence of arrhythmia after PVI with the pentaspline catheter is sparse and so far, the durability of PVI does not seem to be superior to conventional thermal ablation technologies. Purpose We aimed to better understand the location of conduction gaps in reconnected pulmonary veins (PVs) after PVI with the pentaspline PFA catheter to potentially improve PVI durability in future. Methods All repeat procedures of patients who underwent PVI with the pentaspline PFA catheter at our center between 2021 and 2024 were analyzed. Repeat procedures were performed with a 3D-electroanatomical mapping system and radiofrequency ablation. In case of PV reconnection, the site of the gap or the sites of multiple gaps were assessed if possible. Gap location was assigned to a quadrant (antero-superior, antero-inferior, postero-superior, postero-inferior) for each PV. Results We analyzed a total of 101 repeat procedures and 400 pulmonary veins including 4 left common PVs (LCPV). Of these, 268 PVs (67%) were initially treated with the 31 mm pentaspline catheter and 132 PVs (33%) with the 35 mm device. A reconnection was found in 67/400 (16.8%) of PVs. No statistically significant difference in reconnection rate was observed between the 31 mm and the 35 mm catheter. We were able to localize 58 conduction gaps (Figure 1). The most frequently reconnected PV was the right inferior pulmonary vein (RIPV) with 21/100 PVs, while the LCPV had the highest rate of reconnection (2 of 4 PVs). The most common conduction gap site was at the antero-inferior aspect of the RIPV (12 gaps). Conclusion To the best of our knowledge, we present the largest analysis of conduction gap sites after pulmonary vein isolation with the pentaspline PFA catheter to date. Our analysis shows the most prevalent gap at the antero-inferior aspect of the RIPV, where the short distance between the transseptal puncture site and the PV ostium may handicap catheter manipulation and lead to poor catheter-tissue contact. Awareness of this fact may aid in improving PVI durability.Sites of conduction gaps