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Updated: Feb 25, 2026
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Real-Time 3D Mapping Corrects Fluoroscopic Misperception During Pulmonary Vein Isolation by Pulsed Field Ablation.
Grégoire Massoullié1,2, Saer Abu-Alrub1,2, Frederic Jean1
1Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Journal of Cardiovascular Electrophysiology
|February 24, 2026
Summary
Real-time 3D electroanatomical mapping (3D-EAM) significantly improved pulmonary vein (PV) targeting accuracy during pulsed field ablation (PFA). This novel guidance reduced unnecessary applications and eliminated missed veins, enhancing procedural quality.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Pulsed field ablation (PFA) for pulmonary vein isolation (PVI) traditionally relies on fluoroscopy.
- A new electroanatomical module allows real-time 3D mapping (3D-EAM) integrated with PFA catheters.
Purpose of the Study:
- To evaluate the effectiveness of 3D-EAM in improving PV targeting accuracy and lesion coverage during PFA.
- To compare 3D-EAM guided PFA with fluoroscopy-only and 3D-blinded approaches.
Main Methods:
- Prospective study with two phases: 3D-blinded mapping (n=21) and real-time 3D-EAM guidance (n=45).
- Retrospective control group using fluoroscopy-only PFA (n=77).
- Comparison of lesion coverage, PVI applications, and left atrial dwell time across groups.
Main Results:
- Real-time 3D-EAM guidance resulted in no missed PVs, unlike the 3D-blinded phase (23.8% failure).
- 3D-EAM significantly reduced PVI applications (33.6 vs. 38.4/39.3) but increased left atrial dwell time (23.6 vs. 16.7 min).
- Overall lesion coverage was satisfactory in 91.5% of PVs.
Conclusions:
- Real-time 3D-EAM enhances PV targeting, reduces unnecessary applications, and eliminates missed veins in PFA procedures.
- Integrating 3D mapping into PFA workflows is safe, feasible, and improves procedural quality.
- Further research is needed to assess long-term outcomes and durability.
