Durability of atrial linear lesion sets using a dual-energy lattice-tip catheter: Data from invasive remapping

Atrial linear lesion sets are commonly performed as adjunctive ablation to pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and/or macro-reentrant atrial tachycardia (AT). Long-term durability of atrial linear lesion sets remains suboptimal with radiofrequency ablation (RFA) and current catheter designs.

We aimed to assess the durability of linear lesions created with a dual-energy lattice-tip catheter allowing for pulsed field ablation (PFA) and RFA.

The durability of de novo linear lesions sets was assessed via remapping data from patients who previously underwent atrial ablation.

Remapping data were available in 39 of 252 (16%) patients after a median of 46 days (interquartile range [IQR] 30-167) following the initial ablation procedure (74 years [IQR 61-78], 41% female, LVEF 60% [IQR 45-60], CHADS-VA-Score 3 [IQR 1-4], 77% persistent AF, 44% with concomitant AT). Indications for remapping were recurrent arrhythmias in 14 patients (36%) and left atrial appendage (LAA) occlusion after previous LAA isolation in 25 patients (64%). In total, 36 pulmonary veins (PVs), 6 roof lines, 10 posterior box lesions, 17 anterior lines, 13 mitral isthmus lines, and 7 cavotricuspid isthmus (CTI)-lines were re-assessed. 31 of 36 PVs (86%) and 54 of 71 linear lesions (76%) were durably isolated/blocked (roof lines: 6/6 [100%]; posterior box lesions: 10/10 [100%]; anterior lines: 9/17 (53%); mitral isthmus lines: 7/13 [54%]; CTI: 7/7 [100%]).

A novel lattice-tip ablation catheter allowing for PFA and RFA creates durable mid-term posterior box, CTI, and roof lines. Durability of anterior and mitral isthmus lines remains suboptimal in this case series.