The Clinical Utility of 3D Electroanatomical Mapping for Atrial Fibrillation Ablation by Pulsed Field Ablation
Robert N Kerley1, David Keane1,2
1Department of Cardiology St. Vincent's University Hospital Dublin Ireland.
Background:
Pulsed Field Ablation (PFA) is a tissue-selective ablation energy source that has been introduced recently for atrial fibrillation (AF) ablation. Data on the use of 3D electroanatomic mapping (EAM) is limited in AF ablation by PFA with many centers electing to omit it.
Objective:
This study sought to investigate the utility of high-density 3D EAM using PFA for AF ablation.
Methods:
Seventy-four patients with symptomatic AF underwent PFA-based pulmonary vein isolation (PVI). Additional ablation, including left atrial posterior wall (LAPW) and mitral-isthmus (MI) ablation was performed in a subset of patients. The primary efficacy endpoint was freedom from atrial arrhythmia at 12 months. The primary safety endpoint was freedom from a composite of serious procedure- and device-related adverse events.
Results:
In 74 patients, 3D EAM post-PFA showed early PV reconnection in 7/74 cases, (9% cases; 289/296 PVs, 2.4% PVs), most commonly in the right superior PV (6/7, 85.7%). The LAPW reconnected in 3/55 cases (5.5%), while the MI line reconnected in 6/14 cases (30%), more commonly with an anterior approach compared to a posterior (57% vs. 15%). The procedure time was 88.3 ± 40.7 min and fluoroscopic time was 12.1 ± 8.0 min. At 1 year, estimated freedom from atrial arrhythmia was 78.4% (95% CI, 70.1 to 88.7). There was 1 case of pericardial tamponade.
Conclusion:
Our results suggest that although there is a low incidence, early PV reconnection can still occur using PFA for PVI. Overall 3D EAM retains clinical value in AF ablation by PFA.
