The Olive Strategy: Improved Pulmonary Vein Isolation Durability With the Pentaspline Pulsed Field Catheter

The pentaspline pulsed field ablation (PFA) catheter is rapidly gaining popularity as a tool for pulmonary vein isolation (PVI). Its standard ablation protocol recommends applying 8 applications per pulmonary vein (PV) with 2 different catheter configurations: the flower and the basket shape. Using this protocol, the rate of durably isolated PVs during repeat procedures is not superior to that after conventional thermal PVI.

This study aimed to improve PVI durability with the pentaspline PFA catheter through an extension of the ablation protocol and the introduction of a novel catheter shape.

The authors added 2 applications in a small olive-shaped catheter configuration, leading to a total of 10 applications per PV. Procedural data, safety data, and remapping data from patients undergoing repeat procedures and clinical outcomes were analyzed.

A total of 400 consecutive patients were treated with the new olive strategy. In patients undergoing repeat procedures, PV reconnection was significantly less frequent after PVI with the olive strategy (13.6% [3 of 22 patients]) than after the conventional strategy (45% [36 of 80 patients]; P = 0.007). Procedure-related complications occurred in 11 (2.75%) of 400 patients. Comparison of 100 patients treated with the olive strategy vs 100 propensity score-matched conventional patients found no difference in freedom of arrhythmia at 180 days after the procedure (olive strategy: 86%; conventional strategy: 87.3%; P = 0.75).

The authors report on the initial clinical experience of a novel ablation protocol for PVI with the pentaspline PFA catheter. The Olive Strategy is safe to use and significantly improves PVI durability.