A Focal Ablation Catheter Toggling Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation

Vivek Y. Reddy*, Petr Peichl, Elad Anter, Gediminas Rackauskas, Jan Petru, Moritoshi Funasako, Kentaro Minami, Jacob S. Koruth, Andrea Natale, Pierre Jais, Germanas Marinskis, Audrius Aidietis, Josef Kautzner, Petr Neuzil

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Because of its safety, “single-shot” pulsed field ablation (PFA) catheters have been developed for pulmonary vein isolation (PVI). However, most atrial fibrillation (AF) ablation procedures are performed with focal catheters to permit flexibility of lesion sets beyond PVI. Objectives: This study sought to determine the safety and efficacy of a focal ablation catheter able to toggle between radiofrequency ablation (RFA) or PFA to treat paroxysmal or persistent AF. Methods: In a first-in-human study, a focal 9-mm lattice tip catheter was used for PFA posteriorly and either irrigated RFA (RF/PF) or PFA (PF/PF) anteriorly. Protocol-driven remapping was at ∼3 months postablation. The remapping data prompted PFA waveform evolution: PULSE1 (n = 76), PULSE2 (n = 47), and the optimized PULSE3 (n = 55). Results: The study included 178 patients (paroxysmal/persistent AF = 70/108). Linear lesions, either PFA or RFA, included 78 mitral, 121 cavotricuspid isthmus, and 130 left atrial roof lines. All lesion sets (100%) were acutely successful. Invasive remapping of 122 patients revealed improvement of PVI durability with waveform evolution: PULSE1: 51%; PULSE2: 87%; and PULSE3: 97%. After 348 ± 652 days of follow-up, the 1-year Kaplan-Meier estimates for freedom from atrial arrhythmias were 78.3% ± 5.0% and 77.9% ± 4.1% for paroxysmal and persistent AF, respectively, and 84.8% ± 4.9% for the subset of persistent AF patients receiving the PULSE3 waveform. There was 1 primary adverse event—inflammatory pericardial effusion not requiring intervention. Conclusions: AF ablation with a focal RF/PF catheter allows efficient procedures, chronic lesion durability, and good freedom from atrial arrhythmias—for both paroxysmal and persistent AF.

Original languageEnglish
Pages (from-to)1786-1801
Number of pages16
JournalJACC: Clinical Electrophysiology
Volume9
Issue number8
DOIs
StatePublished - Aug 2023
Externally publishedYes

Keywords

  • atrial fibrillation
  • catheter ablation
  • cavotricuspid isthmus
  • lattice tip
  • lesion durability
  • mitral isthmus
  • pulmonary vein isolation
  • pulsed field ablation
  • roof line
  • temperature controlled

Fingerprint

Dive into the research topics of 'A Focal Ablation Catheter Toggling Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation'. Together they form a unique fingerprint.

Cite this