Ariadne's thread: a standardized mapping workflow using a pentaspline pulsed-field ablation catheter for pulmonary...

Pentaspline pulsed-field ablation (PFA) catheters with integrated three-dimensional mapping allow anatomical reconstruction and ablation with a single device. However, standardized catheter-manipulation workflows for reproducible left atrial mapping with these systems remain limited.

Ariadne's Thread is a standardized pulmonary vein (PV)-anchored mapping workflow based on sequential guidewire positioning in each PV, basket-configuration acquisition, gradual catheter pullback from the PV sleeve to the ostium and antrum, and controlled sheath rotation. Repetition of this sequence from the four PVs generates intersecting trajectories that provide broad PV-antral and posterior left atrial coverage, while roof acquisition is completed by reducing guidewire tension and redirecting the basket superiorly.

The workflow is intended for PVI/posterior wall isolation (PWI)-oriented anatomical reconstruction rather than comprehensive high-density substrate mapping. Anterior left atrial, left atrial appendage-PV ridge, septal, and narrow conduction-channel regions may be incompletely sampled and should be assessed with supplementary targeted or dedicated high-density mapping when clinically required.

Ariadne's Thread provides a structured single-catheter approach to left atrial anatomical mapping during PFA-based PVI/PWI, standardizing catheter manipulation while defining the anatomical scope and limitations of the technique.