Impedance-based electroanatomical mapping with a pentaspline pulsed field catheter to guide atrial fibrillation ablation: a prospective series

Abstract Background Pulsed field ablation (PFA) of atrial fibrillation (AF) using a pentaspline multi-electrode catheter is commonly performed under fluoroscopic guidance. No data exist on the integration of this catheter within a three-dimensional electroanatomical mapping (3D-EAM) system for left atrial voltage and activation mapping, posterior wall isolation (PWI), or redo ablation. Purpose To assess the feasibility of impedance-based mapping using the single-shot pentaspline PFA catheter itself within an open architectural EAM system, and identify advantages and limitations of this approach over fluoroscopy only. Methods In this prospective series, impedance-based 3D-EAM within an open architectural EAM system was performed using the pentaspline PFA catheter itself. Cases involved real-time visualisation of the guidewire tip and PFA catheter within the 3D-EAM system. In certain cases, additional 3D-EAM was performed with a grid-style high-density mapping catheter for comparison. Results We studied 22 patients (45% female, mean age 63±13 years, 55% paroxysmal AF, 27% redo procedures). Five patients underwent concomitant high-density mapping, and six received PWI. Mapping increased procedural times (mean 108 mins, vs. 68 mins in fluoroscopy-only controls), without reducing fluoroscopy times. We identified three lessons: (1) The approach helped identify sleeves of incomplete pulmonary vein isolation (PVI) after index applications (Figure 1); (2) Mapping with the PFA catheter appeared concordant with the grid-style mapping catheter (Figure 2); (3) The technique facilitated robust PWI and helped identify inadvertent partial PWI. The cost-effectiveness of this approach requires formal assessment (additional equipment cost of £912 over fluoroscopy-only). Conclusion 3D-EAM with a pentaspline PFA catheter is feasible, with potential advantages over fluoroscopic-only guidance or mapping with an additional high-density mapping catheter. This approach requires further workflow optimisation to minimise procedure duration, along with analysis of cost-effectiveness.Figure 1 Figure 2