Comparison of Two Different Pulsed Field Ablation Systems: The Dual Pulse System Study

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Pulsed field ablation (PFA) systems are emerging for catheter ablation (CA) of atrial fibrillation (AF).
• Real-world data comparing different PFA systems regarding procedural efficiency, low-voltage areas (LVA), and myocardial injury is limited.

Purpose of the Study:

• To compare the procedural performance, extent of acute antral LVA, and myocardial injury between two commercially available PFA systems: Pentaspline catheter system (PCS) and loop catheter system (LCS).

Main Methods:

• A total of 120 patients undergoing de novo pulmonary vein isolation (PVI) for AF were enrolled.
• PFA was performed using either PCS (n=90) or LCS (n=30).
• Acute antral LVA was assessed by 3D-electroanatomical mapping, and myocardial injury was evaluated by high-sensitivity cardiac troponin T (hs-cTnT) levels post-procedure.

Main Results:

• All patients achieved acute PVI.
• The PCS group showed significantly shorter total procedure duration, left atrial dwell time, and ablation duration compared to the LCS group.
• PCS was associated with significantly smaller acute antral LVA and lower hs-cTnT levels, indicating less myocardial injury, compared to LCS.

Conclusions:

• Significant differences exist between the evaluated PFA systems.
• PCS offers advantages in procedural efficiency and reduced myocardial injury compared to LCS in AF ablation.
• Further research may explore long-term outcomes and optimal utilization of different PFA technologies.