Early experience with intracardiac echocardiography in 3d-navigated pentaspline pulsed field ablation: a multicentre registry analysis
S Tubek, B Zuchowski, P Niewinski, K Nowak, M Kusmirek, M Milda, M Dziarmaga, A Jechorek, A Wykretowicz, P Ponikowski, J BaranAbstract
Introduction
Intracardiac echocardiography(ICE), when used in combination with a pentaspline pulsed field ablation(PFA) catheter for pulmonary vein isolation(PVI), has been shown to improve procedural success rates, reduce reconnection rates, and tend to decrease fluoroscopy time[1,2]. However, the latter was not significant, which was justified by the heterogeneity of the studied groups in terms of out-of-pulmonary veins substrate ablation. Moreover, data on the use of ICE in procedures employing novel 3D-navigated pentaspline catheters remain limited.
Purpose
To evaluate the impact of ICE on procedural metrics of PVI performed with a 3D-navigated pentaspline PFA catheter in a balanced population.
Methods
We analyzed the first 100 patients included in the Multicentre Registry for 3D-navigated PFA pocedures, collecting data from three Polish centres. Among these, 20 PVI procedures were performed under elective ICE guidance between March and June 2025, during the early adoption phase of the 3D-navigated pentaspline catheter in Poland. Propensity score matching was performed using a logistic regression model including age, body mass index, left atrial volume index, CHA2DS2-VASc score, heart failure, number of repeat PVI procedures, atrial fibrillation type (paroxysmal vs. persistent), and out-of-pulmonary vein (PV) ablation status to minimise intergroup variability. Procedural parameters—skin-to-skin time, fluoroscopy time, number of energy applications, and application distribution—were compared using the Student’s t-test or Mann–Whitney U test, as appropriate. Correlations were assessed using Spearman’s rank test, and categorical variables were compared using Fisher’s exact test.
Results
Baseline demographic and clinical characteristics were comparable between groups (Figure1A). ICE use was associated with significantly shorter fluoroscopy time (365±122s vs. 576±168s; p<0.001) but longer skin-to-skin time (76.5±15 min vs. 58.1±13 min; p<0.001). The mean total number of energy applications was lower in the ICE group (49±11 vs. 59±11; p=0.007), as was the mean number per PV (10.1±1.5 vs. 11.8±2.9; p=0.02). Additional applications for the left (0.4±1.8 vs. 2.6±2.5) and right carina (0.4±1.8 vs. 4.1±1.7) were also significantly fewer in the ICE group (both p<0.001) – Figure2. Out-of-PV ablation was performed in 12 cases in each group, with a comparable number of applications (Figure1B). No significant periprocedural complications were found in the studied population.
Conclusions
The use of ICE during 3D-navigated pentaspline PVI was associated with a significant reduction in fluoroscopy time and the number of energy applications per PV, despite a modest increase in overall procedure duration. ICE guidance may enhance procedural precision and efficiency while reducing radiation exposure. Further studies in larger populations with extended follow-up are warranted to confirm its effect on long-term efficacy and safety outcomes.Figure 2