Impact of Curarization on Pentaspline Catheter Stability During Pulsed-Field Pulmonary Vein Ablation

Pulsed field ablation (PFA) is effective for pulmonary vein isolation (PVI), but phrenic nerve stimulation during applications may induce diaphragmatic contractions and destabilize catheter positioning. This study evaluated whether neuromuscular blockade improves catheter stability.

Seventy-six patients undergoing PFA under general anesthesia were prospectively enrolled across three centers. Curarization was assessed using train-of-four (TOF). Catheter motion was measured fluoroscopically, including diaphragmatic excursion, lateral displacement, axial entry into the vein, and inadvertent venous intubation.

Sixty-five patients (85%) received curare. In right pulmonary veins, catheter and diaphragmatic motion increased progressively with higher TOF. Compared with TOF 0, absence of curare resulted in greater diaphragmatic excursion, increased lateral and axial catheter movement, and more frequent venous intubation (all p < 0.001). Higher TOF (≥ 4) remained an independent predictor of excessive motion. Left-sided veins showed limited motion across TOF levels.

Inadequate neuromuscular blockade is strongly associated with catheter instability during right-sided PFA. Maintaining TOF ≤ 3 improves stability and may enhance procedural safety. Larger studies are needed to assess long-term impact.