The real-world performance of the lattice tip catheter with a dual-energy option in redo AF ablation procedures
S Boveda, K R J Chun, G B Chierchia, A Metzner, J Lyne, V Tscholl, K A Van Bragt - Dekker, V Obidigbo, J Kautzner, P Jais, T ReichlinAbstract
Background/Introduction
The all-in-one mapping and dual-energy radiofrequency (RF) and pulsed field (PF) ablation catheter with a large focal (9mm) lattice-tip (LFLT) has demonstrated the ability to create durable pulmonary vein isolation (PVI) and linear lesions.
Purpose
To evaluate the acute performance and safety of the LFLT ablation system for treating recurrent atrial tachyarrhythmia (ATA) in patients who previously underwent atrial fibrillation (AF) ablation.
Methods
The APEX Registry is a prospective, multi-center, observational post-market registry involving a broad patient population treated with the LFLT catheter and proprietary mapping platform. All patients experiencing recurrent ATA after prior AF ablation were included in this analysis. Type of arrhythmia recurrence, the ablation lesion sets (including the number of applications and the energy source), as well as acute success and a predefined composite endpoint of primary safety events at 7 days were evaluated.
Results
At the time of analysis, 311 patients in the registry were treated for ATA following prior AF ablation (66 ± 12 years, left atrial diameter 49 ± 10mm, CHA2DS2-VASc 2.4 ± 1.6). At baseline, 76.5% of patients were on class I-IV anti-arrhythmic drugs. Nearly half of the procedures were successfully performed under deep sedation (46.0%). The majority (N=213; 68.5%) were treated for recurrent AF, 133 (42.8%) for atrial flutter, 68 (21.9%) for atrial tachycardia and 8 (2.6%) for other arrhythmias (arrhythmias not mutually exclusive). PVI-only procedure was performed in 14 (4.5%) patients, while 108 (34.7%) received PVI plus additional linear lesions (PVI+) and 189 (60.8%) received non-PVI linear lesions only. PVI-only procedures were completed in a median time of 54 [47–77] min using 46 [35-66] PF and 0 [0-2] RF applications, PVI+ procedures took a median of 76 [65–110] min and 52 [31-81] PF and 9 [0-19] RF applications, while non-PVI only procedures were completed in 76 [58–99] min with 31 [19-47] PF and 11 [2-20] RF applications. A total of 122 patients (39.2%) had ≥1 pulmonary vein (PV) treated (Table 1), and 31 patients had ≥4 PVs treated. PF was the predominant energy source used for PVI, and acute success was 100% across 280 treated PVs. Most patients required linear lesions outside PVs (N=297; 95.5%). Overall, acute success (99.9%) was achieved across all 830 linear lesions, with the exception of 1 mitral isthmus line. The primary safety rate was 1.6%; 1 pulmonary edema, 2 strokes, 1 vascular access complication requiring intervention, and 1 patient developed sinus arrest that eventually required a pacemaker in the days post ablation. In addition, one transient coronary spasm was observed during cavotricuspid isthmus ablation.
Conclusions
In a real-world experience, the LFLT catheter proved effective for mapping and ablating recurrent ATA, targeting a wide variety of lesions with high rates of acute success and few serious complications.