Optimizing electrode spacing of a pentaspline pulsed field ablation catheter for high-precision 3D mapping
Shu Yoshihara1, Kazuyoshi Suenari2, Yoshikazu Watanabe3
1Department of Clinical Engineering, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Background:
Pulsed field ablation (PFA) is emerging as a nonthermal and myocardium-selective therapy for atrial fibrillation. Integration of the FARAWAVE™ catheter with the EnSite™ X three-dimensional electroanatomical mapping (3D-EAM) system remains in development, and the optimal display style, interelectrode spacing, and field scaling (FS) settings have not been established.
Objective:
To determine the optimal visualization configuration of the FARAWAVE™ catheter for achieving high geometric accuracy in 3D mapping.
Methods:
We retrospectively analyzed 25 patients with atrial fibrillation who underwent PFA using the FARAWAVE™ pentaspline catheter visualized on the EnSite™ X system. Four configurations were tested: Medusa style (2.5 mm) and Garland styles (1-17-1 mm, 1-12-1 mm, and 1-11-1 mm). CT-derived left atrial anatomies were compared with electroanatomical reconstructions using ten concordance metrics (six distances and four angles). Accuracy was assessed with mean absolute error (MAE), Scale Score, Angle Score, and Shape Similarity.
Results:
Distance-based MAE differed significantly among configurations (p < 0.05). The Garland 1-11-1 mm + FS setting achieved the lowest MAE (4.3-12.4 mm), while Garland 1-17-1 mm had the highest (8.5-28.4 mm). Scale Score also varied significantly (p < 0.001), whereas Angle Score and Shape Similarity were comparable across configurations.
Conclusion:
The Garland 1-11-1 mm configuration with Field Scaling provided the most accurate geometric concordance with CT anatomy. Optimized catheter display and FS correction can improve mapping fidelity and procedural safety in pulsed field ablation.
