Assessment of incomplete lesions using 3-dimensional mapping following pentaspline pulsed field ablation for atrial fibrillation

Le résumé fourni par la source

Background Pulsed field ablation (PFA) is a novel non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, the completeness of lesion formation following PFA using a penta-spline catheter remains insufficiently studied. Objective To evaluate the utility of three-dimensional (3D) electroanatomical mapping in detecting incomplete lesion formation following penta-spline PFA in patients with AF. Methods This study included 100 consecutive patients undergoing first-time PFA with the Farawave™ catheter (Boston Scientific) under fluoroscopic guidance. Fifty patients with paroxysmal AF underwent PVI alone, while fifty with persistent AF received PVI plus posterior wall isolation (PWI). Post-ablation 3D mapping was performed using the CARTO 3 system. Incomplete lesions were defined as preserved electrical activity or conduction gaps on activation or electrogram mapping. Results Incomplete lesions were identified in 8/50 (16%) of patients undergoing PVI alone and 24/50 (48%) of patients undergoing PVI plus PWI (P<0.001). The most common sites of residual conduction were the right inferior PV (PVI group) and the mid-to-inferior posterior wall (PVI plus PWI group). Five of 24 patients (21%) with incomplete PWI required multiple application–remapping cycles to achieve lesion completion. Analysis by quartile (n = 25) revealed no significant trend in detection rate over time for paroxysmal ( P = 0.289) or persistent AF ( P = 0.179). Conclusion 3D electroanatomical mapping effectively identifies incomplete lesions following penta-spline PFA. Detection rates were unaffected by operator learning curve, instead reflecting limitations of conventional guidance based primarily on fluoroscopy in patients with anatomical variability.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.