Artificial Intelligence-guided Extra-pulmonary Vein Repeat Ablation with the Pentaspline Pulsed Field Ablation Catheter.

The safety and efficacy of pulsed field ablation (PFA) for cardiac ablation have been demonstrated in pulmonary vein (PV) isolation (PVI), but its relevance to target additional extra-PV substrate is still under investigation. We conducted a pilot, prospective, single-center, nonrandomized study in 25 patients with atrial fibrillation despite previous catheter ablation (52% men; 74 ± 9 years of age). Patients underwent catheter ablation using PFA with the goal of ablating artificial intelligence (AI)-guided spatiotemporal dispersion. Biatrial mapping of spatiotemporal dispersion was obtained using the Volta AF-Xplorer™ (Volta Medical, Providence, RI, USA). Re-conducting PVs and extra-PV regions of interest exhibiting dispersion were ablated using the Farawave™ catheter (Boston Scientific, Marlborough, MA, USA). This catheter was used either in the basket or flower configuration sequentially centered at an estimated geometric center of AI-detected dispersion regions. The mean procedure and biatrial mapping times were 75 ± 12 and 14 ± 7 min, respectively, and no fluoroscopy was used. No complications occurred, and sinus rhythm conversion by ablation was obtained in 23 patients (92%). The rate of freedom from any atrial arrhythmia at 6 months was 88%. In conclusion, we observed that PFA for personalized, AI-guided extra-PV dispersion repeat ablation appears safe and procedurally efficient.