The "Jellyfish Method": an in-vitro validated troubleshooting technique for anatomical challenges in pentaspline PFA
T Kanda, H Minamiguchi, Y Shibuya, T Sakio, M Matsumura, O IidaAbstract
Background/Introduction
Pulsed field ablation (PFA) with the pentaspline system is effective for atrial fibrillation, but anatomical challenges, particularly in small pulmonary veins (PVs) like the right inferior PV (RIPV), frequently cause unstable contact and high-impedance errors, leading to procedural failure.
Purpose
We introduce a novel troubleshooting technique, the "Jellyfish Method," designed to overcome these anatomical limitations. We aimed to validate its biophysical advantages in-vitro and report its prevalence and utility in a consecutive clinical cohort.
Methods
The "Jellyfish Method" is a novel configuration where the five splines are aligned parallel to the PV's course, optimising contact. First, to characterise its biophysical properties, an in-vitro study using 17-mm and 20-mm potato models compared lesion depth and uniformity (minimum depth) between Jellyfish, Basket, and Olive configurations. Second, we retrospectively analysed 149 consecutive patients undergoing first-time PVI to determine the clinical prevalence, anatomical distribution, and success of this method.
Results
The in-vitro study confirmed the method's biophysical superiority for small anatomies. In the 17-mm model, the Jellyfish configuration created significantly deeper and, crucially, more uniform lesions. It achieved a minimum perpendicular depth of 2.7 mm, far superior to the Basket configuration (0.5 mm), which showed gaps. This in-vitro advantage was directly reflected in clinical practice. The Jellyfish Method was required as a troubleshooting technique in 34 of 149 patients (22.8%) to overcome impedance errors or instability. The technique was most frequently deployed in the Right Inferior PV (32/34 patients, 94.1%), followed by the Right Superior PV (9/34, 26.5%). In all 34 cases, switching to the Jellyfish method immediately resolved the initial failure, enabling successful PVI.
Conclusion(s)
The "Jellyfish Method," validated in-vitro for superior lesion uniformity in small anatomies, is a critical troubleshooting technique required in over 20% of pentaspline PFA procedures. It provides a simple, reproducible solution for anatomically challenging PVs, particularly the RIPV, ensuring procedural success by preventing impedance errors and expanding the system's applicability.The "Jellyfish Method" validationClinical data of the Jellyfish Method