Durability of Atrial Linear Lesion Sets Using a Dual-energy Lattice-tip Catheter: Data from Invasive Remapping

BACKGROUND: Atrial linear lesion sets are commonly performed as adjunctive ablation to pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and/or macro-reentrant atrial tachycardia (AT). Long-term durability of atrial linear lesion sets remains suboptimal with radiofrequency ablation (RFA) and current catheter designs. OBJECTIVE: To assess the durability of linear lesions created with a dual energy lattice-tip catheter allowing for pulsed field ablation (PFA) and RFA. METHODS: The durability of de-novo linear lesions sets was assessed via remapping data from patients who previously underwent atrial ablation. RESULTS: Remapping data were available in 39/252 (16%) patients after a median of 46 (IQR 30-167) days following the initial ablation procedure (74 years [IQR 61-78], 41% female, LVEF 60 [IQR 45-60] %, CHADS-VA-Score 3 [IQR 1-4], 77% persistent AF, 44% with concomitant AT). Indications for remapping were recurrent arrhythmias in 14 patients (36%) and left atrial appendage (LAA)-occlusion after previous LAA isolation in 25 patients (64%). In total, 36 pulmonary veins (PV), 6 roof lines, 10 posterior box lesions, 17 anterior lines, 13 mitral isthmus lines, and 7 cavotricuspid isthmus (CTI)-lines were re-assessed. 31/36 (86%) PVs and 54/71 (76%) linear lesions were durably isolated/blocked (roof lines: 6/6 (100%); posterior box lesions: 10/10 (100%); anterior lines: 9/17 (53%); Mitral isthmus lines: 7/13 (54%); CTI: 7/7 (100%)). CONCLUSIONS: A novel lattice-tip ablation catheter allowing for PFA and RFA creates durable mid-term posterior box, CTI, and roof lines. Durability of anterior and mitral isthmus lines remains suboptimal in this case series.