Pulsed field ablation for pulmonary vein isolation in atrial fibrillation: comparison between mapping integrated and non integrated 3D mapping systems
L Rossi, A Dello Russo, A Setzu, C Ghiglieno, F Figus, G Mitacchione, S Bianchi, F Solimene, R Calvanese, P De Filippo, G Rovaris, M Giannotti Santoro, S Iacopino, M Malacrida, C TondoAbstract
Background
A new generation of pentaspline pulsed-field ablation (PFA) catheters with integrated three-dimensional (3D) mapping capability has recently become available. However, comparative data on procedural workflow and efficiency relative to non-integrated 3D mapping systems are lacking.
Purpose
To evaluate procedural workflow and efficiency of a novel mapping-integrated PFA system for pulmonary vein isolation (PVI), compared with a non-integrated 3D mapping system in current clinical practice.
Methods
This multicenter observational study included consecutive patients undergoing first-time atrial fibrillation ablation using Farapulse PFA across 17 Italian centers. Patients treated with the integrated Faraview mapping PFA system (FAR group) were compared with a historical cohort using Farapulse with a non-integrated 3D mapping system (i.e. Orion, HD-Grid or Pentaray/Octaray; MAP group). Cases involving ablation beyond PVI were excluded. For each PV, ablation workflow was characterized by the number of PFA deliveries, catheter configuration, and deviation from the planned to actual approach.
Results
A total of 510 patients were included: 224 (43.9%) in FAR group, 286 (56.1%) in MAP group. Overall mean cath lab utilization time, skin-to-skin time, and fluoroscopy time were 114±42 min, 79±32 min and 16.2±8 min, respectively; the mean number of PFA deliveries was 41.6±11. FAR procedures had shorter cath lab utilization time (100±38 min vs 125±41 min, p<0.001), skin-to-skin time (68±25 min vs 86±34 min, p<0.001) and fluoroscopy time (13±7 min vs 18±9 min, p<0.001) than MAP procedures. In the FAR group the number of PFA deliveries was higher than MAP procedures (45±12 vs 39±10, p<0.001). Figure 1. In the FAR group, 857 PVs were characterized for workflow analysis. The actual number of PFA deliveries per PV exceeded the planned number (10.8±4 vs 9.1±2; p<0.001; mean difference: 1.6±3). The frequency of additional deliveries varied by vein: 47.0% in the right superior PV (RSPV), 36.5% in the right inferior PV (RIPV), 29.0% in the left inferior PV (LIPV), and 20.5% in the left superior PV (LSPV). Figure 2A. Configuration-specific analysis showed a mean of 4.8±2 deliveries in basket configuration (ranging from 4.6±2 in RIPV to 5.1±2 in LSPV) and 5.8±3 in flower configuration (p<0.001; range 5.5±2 in LIPV to 6.0±3 in RSPV). Additional PFA deliveries in flower configuration were performed in 21.5% of PVs, in basket configuration in 6.9% of PVs, and in both configurations in 11.4%. Figure 2B.
Conclusion
In this first multicenter real-world experience with the mapping-integrated pentaspline PFA system, workflow optimization was observed in approximately one-third of targeted PVs, primarily involving additional applications in flower configuration. The integrated mapping system enabled shorter procedure and fluoroscopy times while supporting flexible ablation strategies and efficient lesion delivery compared with non-integrated 3D mapping systems.