Chronic right coronary artery changes after cavotricuspid isthmus ablation using a small-basket pentaspline pulsed...

Pulsed field ablation (PFA) is increasingly used for atrial fibrillation ablation; however, its safety for cavotricuspid isthmus (CTI) ablation, particularly regarding the right coronary artery (RCA), remains unclear.

This study aimed to evaluate the acute and chronic effects of PFA-based CTI ablation on the RCA and to compare procedural outcomes with radiofrequency ablation (RFA).

We retrospectively analyzed 96 patients who underwent an initial CTI ablation during atrial fibrillation ablation and had paired preablation and approximately 6-month follow-up coronary computed tomographic angiography (CCTA) data available from routine clinical care. CTI ablation was performed using a small-basket pentaspline PFA catheter (PFA group n = 55) or an RFA catheter (RFA group n = 41). We assessed RCA stenosis progression using the Coronary Artery Disease Reporting and Data System category and minimal luminal area and also evaluated periprocedural safety and efficacy.

In the PFA group, 54 patients (98.2%) showed no stenosis progression. The Coronary Artery Disease Reporting and Data System category and minimal luminal area did not significantly change between preablation and follow-up CCTA (median [interquartile range] 0 [0-1] vs 0 [0-1], P = .317; 11.3 [8.4-15.1] vs 11.0 [8.0-15.1] mm², P = .828). 1 patient (1.8%) developed a transient RCA spasm, whereas no spasms occurred in the RFA group. In a propensity score-matched analysis, PFA was associated with a shorter procedure time, shorter time to CTI block, and higher first-pass success.

Small-basket PFA for CTI ablation was associated with no major CCTA-detectable progression in the distal RCA in most patients and favorable procedural characteristics compared with RFA. Further prospective studies are needed to confirm long-term safety and efficacy.