Intraprocedural characterization of a "map-on-the-go" navigation strategy with PFA. Comparison with fluoro-based procedures.
V Cesena Baez, A Ochoa-Gonzalez, R A Albarran Rincon, C Pham Trung, E Rodriguez Valle, A Benavente Babace, A Urbiola Garcia, J I Garcia BolaoAbstract
Introduction
Pulsed field ablation (PFA) has emerged as a cornerstone in atrial fibrillation (AF) ablation. Most early PFA experiences have relied on fluoroscopy. The advent of navigation platforms allows real-time visualization of the catheter during PFA, reducing fluoroscopy time without compromising procedural outcomes. This study aims to identify the procedural benefits of a navigation-guided "map-on-the-go" strategy for PFA.
Purpose
Describe the utility of a "map-on-the-go" strategy with a navigation system while performing PFA and modification in procedure times and number of applications.
Methods
Single-center, retrospective, descriptive study. Study subjects where patients admitted to our center from June 2022 to October 2025 for AF ablation with PFA catheter. Patients were divided according to the strategy used and form of presentation: fluoroscopy-only guided procedure (group 1), navigation-guided procedure (group 2), paroxysmal de novo AF (subgroup A), persistent de novo AF (subgroup B) and redo ablation procedures presenting as paroxysmal AF (subgroup C) or persistent AF (subgroup D). Procedure times were documented in minutes as complete procedure time, LA time, ablation time and total fluoroscopy time. Standard PFA ablation protocol with a pentaspline catheter was performed on all patients. Anchoring and posterior wall (PW) applications were performed according to operator preference. In the navigation-guided group, navigation software was utilized for a "map-on-the-go" strategy while the electroanatomical map and applications were performed simultaneously. Application tags were noted and used as reference for PVI and PW ablation.
Results
From June 2022 to October 2025, there were admitted 865 patients to our EP lab for AF ablation while using a PFA. 635 (73%) patients were included in group 1 and 230 (27%) patients in group 2. 402 (49%) were included in subgroup A, 195 (24%) subgroup B, 117 (14%) subgroup C and 101 (12%) in subgroup D. The number of applications did not differ significantly between subgroups. Even though, applications differed significantly in PV anchoring applications in subgroup A (p <0.001), with an increase in the number of applications in group 2A. On the other hand, posterior wall applications in subgroup B (p = 0.01) showed statistical significance with a decrease in the number of applications in group 2B. Fluoroscopy times differed significantly between groups, with a total reduction of approximately 40% in group 2.
Conclusion
The use of navigation-guided PFA with "map on the go" strategy resulted in an increase in the number of applications in PVI anchoring in patients presenting with paroxysmal AF while reducing the number of applications done to PW in most groups. There was a reduction in total fluoroscopy time in all groups. These findings suggest that the use of a navigation-guided approach can optimize protocols while exposing the patient and medical staff to lower fluoroscopy time."Map-on-the-go" strategy during PFA.Procedure times and applications.