Impact of a standardized pacing protocol on end point verification and first pass isolation using a multipolar pulsed-field ablation catheter for pulmonary vein isolation.

Pulsed-field ablation (PFA) has emerged as a novel treatment strategy for patients with atrial fibrillationKlicken oder tippen Sie hier, um Text einzugeben.. 1 Badertscher P. Weidlich S. Serban T. et al. Pulsed-field ablation versus single catheter high-power short-duration radiofrequency ablation for atrial fibrillation: procedural characteristics, myocardial injury and midterm outcomes. Heart Rhythm. 2023; https://doi.org/10.1016/j.hrthm.2023.05.007 Abstract Full Text Full Text PDF Scopus (2) Google Scholar ,2 Reddy V.Y. Dukkipati S.R. Neuzil P. et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol. 2021; 7: 614-627 Crossref PubMed Scopus (104) Google Scholar In general, acute pulmonary vein isolation (PVI) may be confirmed by entrance and exit block. 3 Duytschaever M. de Meyer G. Acena M. et al. Lessons from dissociated pulmonary vein potentials: entry block implies exit block. Europace. 2013; 15: 805-812 Crossref PubMed Scopus (26) Google Scholar The pentaspline PFA catheter provides only larger electrodes and wider interelectrode distance, making such an assessment less reliable. Little is known about the required number of applications when using PFA as systematically assessed via exit block testing. Likewise, since close proximity of the PFA catheter to the pulmonary vein (PV) ostium seems to be of importance, 2 Reddy V.Y. Dukkipati S.R. Neuzil P. et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol. 2021; 7: 614-627 Crossref PubMed Scopus (104) Google Scholar catheter positioning might be optimized by pacing before the first PFA application and adjusting contact depending on the ability to capture the atrial myocardium. Thus, our aims were to assess the number of PFA applications per PV until acute PVI was observed and to assess the impact of a standardized pacing protocol on first pass isolation (FPI) confirmed via electroanatomic mapping (EAM). We prospectively enrolled consecutive patients undergoing their first PVI application. In brief, the 31 mm FARAWAVE PFA catheter (Boston Scientific, Marlborough, MA) was inserted into the left atrium via a single transseptal puncture. PVI was performed as described previously. 2 Reddy V.Y. Dukkipati S.R. Neuzil P. et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol. 2021; 7: 614-627 Crossref PubMed Scopus (104) Google Scholar Patients were divided into 2 groups: in group 1, no standardized pacing protocol was applied before or after PVI. In group 2, pacing was performed before the first application across all 5 bipoles to assess the proximity of the PFA catheter to the PV ostium. Entrance and exit block was then assessed after each PFA application per PV separately. PVI was subsequently confirmed via EAM. The study was approved by the local ethics committees and adhered to the Helsinki Declaration.