Near-Zero Fluoroscopy Ablation Workflow With a Circular Multielectrode Pulsed-Field Ablation Catheter

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) is effective for atrial fibrillation (AF).
• Traditional PVI often requires fluoroscopy, increasing radiation exposure risks.
• A novel workflow using the PulseSelect catheter with 3D electroanatomical mapping (3D-EAM) and intracardiac echocardiography (ICE) aims to minimize fluoroscopy.

Purpose of the Study:

• To evaluate the feasibility and efficacy of a near-zero fluoroscopy PVI workflow for AF treatment.
• To assess the safety and procedural outcomes of using the PulseSelect catheter with 3D-EAM and ICE.

Main Methods:

• Procedures were performed under general anesthesia with transseptal puncture.
• Pre-mapping with a multi-electrode catheter guided visualization of the PulseSelect catheter on 3D-EAM for PVI.
• Post-procedure mapping confirmed isolation and assessed for electrical reconnection.

Main Results:

• Median isolation times were 9.0 min for left and 11.0 min for right pulmonary veins.
• Average total procedure time was 48.5 min, with only 0.1 min of fluoroscopy for initial registration.
• Catheter positioning was controlled with minimal deviation, no significant complications, and a low recurrence rate at three months.

Conclusions:

• The near-zero fluoroscopy PFA workflow using PulseSelect, 3D-EAM, and ICE significantly reduces radiation exposure.
• This approach enhances procedural safety and maintains efficacy for AF ablation.
• The study confirms the feasibility of reducing fluoroscopy reliance while achieving accurate and safe ablation outcomes.