Conventional pulsed-field ablation versus pulsed-field ablation with non-integrated three-dimensional mapping for paroxysmal and persistent atrial fibrillation ablation.

BACKGROUND

There is limited evidence on efficiency, effectiveness, and safety outcomes in the context of pulsed-field ablation (PFA) of atrial fibrillation (AF) when a 3D mapping system is used.

PURPOSE: To assess the impact of non-integrated 3D mapping systems in PFA for the treatment of AF.

METHODS

Consecutive patients undergoing PFA (FARAPULSE system) at 17 centers were included. Procedures were stratified according to the use of 3D mapping system (MAP vs standard; STD).

RESULTS

A total of 1804 patients were included, 484 (26.8%) with a 3D mapping system. MAP procedures had longer skin-to-skin (90 [75-120] min vs. 60 [50-70] min, p < 0.0001), cath lab utilization (120 [100-165] min vs. 70 [60-94] min, p < 0.0001), and fluoroscopy time (22 [17-28] min vs. 15 [11-21] min, p < 0.0001). The use of 3D mapping was not associated with a better long-term clinical outcome in the overall population (freedom from AF/atrial tachycardia (AT) of 82.5% in MAP procedures vs. 77.4% in STD procedures, HR = 0.737, 95% CI 0.53-1.03, p = 0.0746) as well as in PVI-only paroxysmal AF (86.5% vs. 80.3%, 0.67, 0.38-1.19, p = 0.172), in PVI plus additional lesion sets paroxysmal AF (72.7% vs. 77.8%, 1.08, 0.44-2.65, p = 0.869), or in PVI only persistent AF (76.0% vs. 68.0%, 0.86, 0.36-2.04, p = 0.727). A significantly higher arrhythmia recurrence-free rate was noticed in patients with persistent AF undergoing additional lesion set ablation (83.7% vs 70.3%, 0.45, 0.24 to 0.86, p = 0.016). Three major complications (0.2%) occurred, all in the STD group.

CONCLUSION

The use of a non-integrated 3D mapping system for PFA of AF did not significantly affect long-term success rates in paroxysmal AF or in patients undergoing PVI-only procedures.