Safety and Feasibility of Dual-Energy Lattice-Tip Catheter for Cavotricuspid Isthmus Ablation in Patients With Cardiac Implantable Electronic Devices: A Single-Center Experience.

BACKGROUND: Cavotricuspid isthmus (CTI) ablation is a standard therapy for typical atrial flutter. In patients with cardiac implantable electronic devices (CIEDs), ablation near intracardiac leads may present risks, including lead dislodgement, thermal injury, or electromagnetic interference. The dual-energy lattice-tip catheter, capable of delivering both pulsed field ablation (PFA) and radiofrequency (RF) energy, is a novel device designed for CTI ablation and pulmonary vein isolation (PVI). However, data on its safety in patients with CIEDs remain limited.

OBJECTIVES: This study aimed to evaluate procedural safety and short-term device performance of CTI ablation using the dual-energy lattice-tip catheter in patients with CIEDs.

METHODS: We conducted a retrospective, single-center analysis of 67 consecutive patients with CIEDs who underwent CTI ablation during atrial fibrillation or atypical flutter ablation procedures, with the dual-energy lattice-tip catheter between January and October 2025. Baseline demographics, procedural details, and device interrogation data were collected. The primary outcome was procedural safety, including lead dislodgement, device malfunction, and major complications. Secondary outcomes included changes in lead sensing, pacing thresholds, and impedance from baseline to follow-up.

RESULTS: CTI ablation was acutely successful in all 67 patients. Combined RF and PF energy was used in 88% of cases. A total of 75 PFA applications and 158 RF lesions were delivered across the cohort. Patients received an average of 4.7 PFA applications and 9.9 RF lesions. No lead dislodgement or device malfunction occurred. Mean procedure time was 78.2 ± 10.8 min; mean fluoroscopy time was 2.75 ± 1.47 min. Three patients exhibited atrial sensing changes postablation, but all remained stable at follow-up without the need for device reprogramming.

CONCLUSIONS: CTI ablation using a dual-energy lattice-tip catheter appears safe and feasible in patients with CIEDs. Larger prospective studies are needed to validate these findings.