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Difference in Cerebral Microembolization With Multielectrode Pentaspline or Variable-Loop Circular PFA Systems.

Mattia Pagnoni1, Leonardo Caranzano2, Cheryl Teres1

  • 1Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Journal of Cardiovascular Electrophysiology
|December 9, 2025
PubMed
Summary
This summary is machine-generated.

Pulsed field ablation (PFA) using the variable-loop circular catheter (VLCC) resulted in significantly higher and more variable cerebral microembolization compared to the Pentaspline system. This highlights the importance of catheter design in PFA safety.

Keywords:
AF ablationPFAatrial fibrillationcerebral microembolismpulmonary vein isolationstroke

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Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Pulsed field ablation (PFA) is a nonthermal cardiac ablation modality known for myocardial selectivity.
  • Cerebrovascular safety is a key concern in PFA due to potential embolic risks influenced by catheter design and pulse parameters.
  • Microembolic signals (MES), detected via transcranial Doppler (TCD) ultrasonography, serve as a sensitive indicator of embolic activity during procedures.

Purpose of the Study:

  • To prospectively compare the microembolic signal (MES) burden between two distinct PFA catheter systems.
  • To evaluate the impact of catheter design on cerebrovascular safety during PFA procedures for atrial fibrillation.
  • To assess the reproducibility and variability of embolic load associated with different PFA technologies.

Main Methods:

  • A prospective study comparing the Pentaspline catheter (Farawave) and the variable-loop circular catheter (VLCC) (Varipulse) in patients undergoing pulmonary vein isolation for atrial fibrillation.
  • Monitoring of MES using TCD ultrasonography throughout the ablation procedure.
  • Adherence to specific activated clotting time (ACT) targets and manufacturer-recommended PFA delivery workflows for each system.

Main Results:

  • The VLCC system demonstrated a significantly higher MES burden during ablation time compared to the Pentaspline system (919 vs. 102, p=0.005).
  • MES burden, when normalized by PFA delivery ratio, remained significantly higher for VLCC (p=0.005).
  • The VLCC system exhibited greater inter-patient variability in MES burden (IQR 2148) compared to the more reproducible Pentaspline system (IQR 196, p<0.001).

Conclusions:

  • The variable-loop circular catheter (VLCC) PFA system is associated with increased and more variable cerebral microembolization compared to the Pentaspline system.
  • Catheter design and energy delivery strategies significantly influence the embolic load during PFA procedures.
  • Dedicated cerebrovascular safety evaluations are crucial for PFA technologies, considering the impact of device design on embolic risk.