Pulsed-field ablation (PFA) in patients with an implanted extravascular implantable cardioverter-defibrillator (EV-ICD) poses theoretical risks of electromagnetic interference or lead displacement. We report two cases of atrial fibrillation (AF) ablation using the FARAPULSE pentaspline catheter after EV-ICD implantation. In both patients, PFA was successfully performed without significant changes of the parameters/functions of the EV-ICDs. No lead dislodgement was observed on a fluoroscopy examination. These cases suggest that AF ablation using PFA can be safely performed in patients with EV-ICDs.

Pulsed-field ablation (PFA) is an emerging non-thermal ablation technique for the treatment of atrial fibrillation (AF). 25% of patients with hypertrophic cardiomyopathy (HCM) have an history of AF. In patients with HCM, conventional catheter ablation using thermal energy sources, such as radiofrequency (RF) or cryothermal ablation, have shown reduced efficacy in achieving freedom from recurrent atrial arrhythmias. This study aims to assess the outcomes of PFA in comparison to traditional thermal ablation methods in patients with HCM. A retrospective analysis was conducted on patients with HCM and symptomatic AF who underwent pulmonary vein isolation (PVI) between 2019 and 2024. A total of 42 consecutive patients were included, 20 treated using a pentaspline PFA-catheter and 22 with thermal ablation catheters, including radiofrequency, cryo and laser balloon. Follow-up data were successfully obtained for 38 patients. The primary endpoint was freedom from any atrial tachyarrhythmias recurrence. The median age of the cohort was 62 years, persistent AF was present in 45% of patients. No significant baseline difference was found between the two groups. PFA-guided PVI was successfully achieved in all patients, with a mean procedural time of 32 minutes for the PFA group, compared to 71 minutes in the thermal ablation group (P < 0.0001). Fluoroscopy time was comparable between groups (8.5 minutes for PFA vs. 8.3 minutes for thermal ablation, P=0.852). No serious acute adverse events occurred. Freedom from atrial tachyarrhythmias at one year was observed in 88% of patients treated with PFA, versus 57% in the thermal ablation group (log-rank P=0.086). In patients with HCM undergoing PVI for AF, PFA demonstrated a favorable trend toward a lower recurrence rate of atrial tachyarrhythmias at one-year follow-up compared to thermal ablation strategies. These findings suggest that PFA may offer a promising alternative to thermal energy sources in this patient population.Kaplan-Meier survival analysis

The pentaspline pulsed field ablation (PFA) catheter is increasingly used worldwide for pulmonary vein isolation (PVI) to treat atrial fibrillation (AF). The current standard ablation protocol consists of 8 applications per pulmonary vein (PV) with two different catheter configurations: 4 applications with a flower and 4 applications with a basket shape. So far, data from remapping procedures shows PV reconnection rates that are not superior to those after conventional thermal ablation. We sought to improve the durability of PVI with the pentaspline PFA catheter. To achieve this, we extended the ablation protocol to 10 applications per PV. We added 2 applications with a small olive shaped catheter configuration (Figure 1). Consecutive patients who underwent PVI using the olive strategy between 06/2023 and 07/2024 were included. Procedural data and safety data were analyzed. In patients who underwent repeat procedures for recurrent arrhythmia, durability of PVI was analyzed and compared to remapping data from patients who were ablated using the conventional 8-application strategy in our center. Additionally, recurrence of atrial arrhythmia was assessed for the first 100 olive patients and compared to 100 propensity score matched conventional patients. A total of 400 olive strategy patients (mean age 67.2 years, 64% male, 60.2% paroxysmal AF) were included. PVI was successfully achieved in all patients with a mean procedure time of 33.7 minutes and mean fluoroscopy time of 7.5 minutes. Procedure related complications occurred in 11/400 patients (2.75%). Pre- to postprocedural estimated glomerular filtration rate (eGFR) did not change significantly (mean pre: 72.25 ml/min/1,73 m2, mean post: 73.09 ml/min/1,73 m2, p = 0.19). No case of acute kidney injury occurred. In repeat procedures, PV reconnection was significantly less frequent after olive PVI compared to conventional PFA PVI (Figure 2). After olive PVI, 13.6% (3/22) of patients had at least one reconnected PV, compared to 45% (36/80) of patients after conventional PVI (p = 0.007). Overall, only 4.6% (4/87) of all PVs were reconnected in the olive group compared to 20.2% (64/317) in the conventional group (p < 0.001). PV diameters assessed through angiograms did not decrease after olive PVI (pre-PVI mean 19.99 mm, post-PVI mean 20.09 mm, p = 0.51). Freedom of arrhythmia at 180 days after the procedure was not different between the first 100 olive patients (86%) and 100 propensity score matched conventional patients (87.3%, p = 0.75). The novel olive strategy for the pentaspline PFA catheter significantly improves durability of PVI and is safe to use. Our data show neither PV stenosis nor acute kidney injury as a potential sign for hemolysis due to additional pulsed field applications. Longer follow-up data will be available in future and may reveal, whether improved PVI durability leads to improved clinical outcomes.Pentaspline PFA catheter shapes Pulmonary vein isolation durability

ABSTRACT Background Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation; however, recurrences often originate from non‐pulmonary vein (non‐PV) foci. The Complex Signal Identification (CSI) algorithm in CARTO 3 assigns electrogram‐fractionation scores (0–10). This study evaluated the feasibility of CSI‐assisted mapping for identifying non‐PV triggers. Methods We retrospectively analyzed 23 consecutive patients undergoing first‐time AF ablation between January and June 2024. After PVI, non‐PV triggers were induced using isoproterenol and adenosine triphosphate (ATP). When ectopy was absent, rapid pacing during isoproterenol infusion followed by defibrillation was performed, and ATP testing was repeated. High‐density CSI mapping was conducted during sinus rhythm or high right atrial pacing using system default settings, targeting atrial components after ventricular blanking. Results A total of 33 non‐PV foci were localized (20 left atrium [LA], 13 right atrium [RA]). The mean CSI scores of LA and RA foci were 9.0 ± 2.3 and 8.8 ± 2.7, respectively. ROC analysis showed an AUC of 0.917 for discriminating non‐PV foci, with an optimal cutoff of 8.5 (sensitivity 87.9%, specificity 88.3%). At 12 months, arrhythmia‐free survival was 82.4% under symptom‐driven follow‐up. Ablation was selectively performed at the earliest activation and adjacent high‐CSI points, avoiding indiscriminate lesion delivery. Conclusions CSI‐assisted mapping provided practical, adjunctive guidance to provocation and activation mapping for non‐PV focus localization. While apparent discrimination was promising, the 8.5 threshold remains exploratory. Larger multicenter studies with standardized CSI settings and systematic post‐ablation assessment are warranted to validate these preliminary findings.

BACKGROUND:Cryoballoon (CB) pulmonary vein isolation (PVI) is a well-established treatment for symptomatic atrial fibrillation (AF). Most centers use application durations of 180 or 240 s. Since freezing-related complications tend to occur later during the application, empirically shortening the duration may reduce procedural risks. A protocol using two consecutive 120-s freezes was proposed. Here, we report its long-term outcomes. METHODS:We performed a long-term follow-up comparison of patients with symptomatic AF undergoing PVI with second-generation CB between 2019 and 2020. The conventional single 240-s freeze protocol (CB240) was compared to a modified double 120-s freeze protocol (CB120). Among 160 consecutive patients, 80 received CB120 and 80 CB240. A total of 140 patients (70/group) completed follow-up. The primary endpoint was freedom from atrial tachyarrhythmia. RESULTS:Persistent AF was more common in the CB240 group (32%) than in the CB120 group (20%), (p < 0.05). After a mean follow-up of 948 ± 517 days, freedom from any atrial tachyarrhythmia at 1 year was 90% in the CB120 group and 82% in the CB240 group (log-rank p = 0.122). The primary outcome was assessed after a single procedure, including antiarrhythmic drug (AAD) use. CONCLUSIONS:The CB120 protocol appears noninferior to the standard CB240 protocol regarding long-term efficacy, while offering a potentially more favorable safety profile. This protocol may represent a viable alternative for optimizing the balance between effectiveness and safety.

BACKGROUND:The pentaspline pulsed field ablation (PFA) catheter is rapidly gaining popularity as a tool for pulmonary vein isolation (PVI). Its standard ablation protocol recommends applying 8 applications per pulmonary vein (PV) with 2 different catheter configurations: the flower and the basket shape. Using this protocol, the rate of durably isolated PVs during repeat procedures is not superior to that after conventional thermal PVI. OBJECTIVES:This study aimed to improve PVI durability with the pentaspline PFA catheter through an extension of the ablation protocol and the introduction of a novel catheter shape. METHODS:The authors added 2 applications in a small olive-shaped catheter configuration, leading to a total of 10 applications per PV. Procedural data, safety data, and remapping data from patients undergoing repeat procedures and clinical outcomes were analyzed. RESULTS:A total of 400 consecutive patients were treated with the new olive strategy. In patients undergoing repeat procedures, PV reconnection was significantly less frequent after PVI with the olive strategy (13.6% [3 of 22 patients]) than after the conventional strategy (45% [36 of 80 patients]; P = 0.007). Procedure-related complications occurred in 11 (2.75%) of 400 patients. Comparison of 100 patients treated with the olive strategy vs 100 propensity score-matched conventional patients found no difference in freedom of arrhythmia at 180 days after the procedure (olive strategy: 86%; conventional strategy: 87.3%; P = 0.75). CONCLUSIONS:The authors report on the initial clinical experience of a novel ablation protocol for PVI with the pentaspline PFA catheter. The Olive Strategy is safe to use and significantly improves PVI durability.

Pulsed field ablation (PFA) is a novel energy source for cardiac ablation. The pentaspline PFA catheter is the most widely used catheter and is designed to be a single-shot device for pulmonary vein isolation in patients with atrial fibrillation. The high co-incidence between atrial fibrillation and typical cavotricuspid isthmus (CTI) dependent atrial flutter may necessitate CTI ablation during PVI with the pentaspline PFA catheter. We want to examine feasibility and safety of CTI ablation with the pentaspline PFA catheter and provide practical experiences from a large single-center patient cohort. We included all patients who were scheduled for PVI with the pentaspline PFA catheter between 2021 and 2024 but intraprocedurally developed atrial flutter or had a history of atrial flutter and therefore also received CTI ablation with the same catheter. We analyzed procedural data, periprocedural complications, follow-up data and if available data from remapping procedures. Furthermore, we report our workflow with this catheter for CTI ablation and assessment of CTI block after the ablation. A total of 40 patients met criteria for inclusion (mean age 68 years, 75% male). Mean procedure time including PVI was 43 minutes. CTI block was successfully achieved in 39 cases (97.5%). The 31 mm device was used in 35/40 (87.5%) and the 35 mm device in 5/40 (12.5%) cases. Number of pulsed field applications at the CTI ranged from 2 to 12 (median 5). Mean dose of nitroglycerin administered intravenously before ablation was 0.43 mg. No case of coronary vasospasm and no other periprocedural complication occurred. Follow-up data was available for 30/40 patients (75%) with a median follow-up time of 174 days. Recurrence of atrial tachyarrhythmia was recorded in 5/30 patients (17%). Type of recurrence was atrial fibrillation in 4 patients. On e patient experienced recurrence of CTI dependent atrial flutter 149 days after the index procedure, during which the initial CTI ablation was successful. We performed a repeat procedure and confirmed recovery of conduction at the CTI. Despite being designed for PVI, the pentaspline PFA catheter can also be safely and efficiently used for CTI ablation. Manipulation at the CTI can be complicated due to the size of the device. We recommend complete bending of the steerable sheath to face the CTI with a flat flower configuration (Figure 1). For assessment of a successful block after the ablation, the pentaspline catheter can be put into the coronary sinus over the wire and a diagnostic decapolar catheter can be placed in the lateral right atrium (Figure 2a). Alternatively, the pentaspline catheter can be positioned at the RA septum for pacing (Figure 2b). More remapping data is needed to assess durability of the CTI lesions.Catheter placement Block assessment

Early recurrence of atrial tachyarrhythmias (ERAT) after pulmonary vein isolation (PVI) using thermal energy is common, but is not considered a treatment failure within the traditional 90-day blanking period (BP) as the cardiac tissue is still healing and inflammation persists, so that the full benefit of PVI may not yet be apparent. For pulsed-field ablation (PFA), a non-thermal technology, the role of ERAT post-PVI remains unclear. A cohort of 1000 consecutive patients with symptomatic atrial fibrillation (AF) underwent PFA-PVI from April 2021 to April 2024. We analyzed the incidence of ERAT and compared traditional (90-day; ERAT1) and updated (8-week; ERAT2) BPs. Arrhythmia recurrence was defined as AF or atrial tachycardia (AT) episodes lasting over 30 seconds. Patients with repeat procedure in blanking time or with recurrence in blanking that was left untreated were excluded. In all 100 patients (62.7% male, median age 69 [IQR 60-76] years), complete PVI was achieved using solely PFA. Fifteen Patients were excluded due to a repeat procedure or untreated recurrence during BP. Median follow-up (FU) was 331 days and ERAT1 occured in 160/985 (16.2%) patients and was more frequent in persAF (persAF=22.1%; PAF=12.0%; p<0.001). Median time to ERAT1 was 9 [3-31] days. At one-year, overall freedom from atrial arrhythmia outside of ERAT1 was 75.1% and was significantly lower for patients with ERAT1 compared to patients without ERAT1 (ERAT1=47.6%; no ERAT1=81.1%, p<0,001). This difference was significant for both, patients with PAF (ERAT1= 50.3%; no ERAT1= 88.1%; p<0.001) and patients with persAF (ERAT1= 45.0%; no ERAT1= 70.1%; p<0.001). In total, 83/160 (51.9%) of patients with ERAT1 had documented late recurrence (LR), compared to only 152/825 (18.4%) of patients in sinus rhythm throughout BP (p<0.001). When applying the new 8 weeks BP, patients with early recurrence still had a significantly lower freedom from AF/AT at one year compared to patients with no recurrence (ERAT2=49.8%; no ERAT2= 78.1%; p<0,001) and this difference was significant for PAF (p<0.001) and persAF (p=0.013). Furthermore 68/137 (49.6%) of patients with ERAT2 experienced LR, compared to only 175/848 (20.6%; p<0.001) patients who maintained sinus rhythm throughout BP. In this large cohort, early recurrence of atrial tachyarrhythmia following PFA PVI was associated with late recurrences in the majority of cases, even when applying the new blanking period and independent of AF type. This leads to the conclusion that the concept of blanking period following non thermal energy ablation for atrial fibrillation should be further questioned.ERAT1 vs No ERAT1 ERAT2 vs No ERAT2

Introduction:Lead extraction and reimplantation in adult congenital heart disease (CHD) patients is challenging due to anatomical complexity. Case:A 76-year-old man with prior ventricular septal defect (VSD) patch repair and pacemaker implantation developed a device infection. Complete transvenous lead extraction (TLE) was achieved using laser and mechanical sheaths. A leadless pacemaker (Aveir VR) was implanted at the right ventricular outflow tract (RVOT) using pre-fixation mapping to avoid the VSD patch. Conclusion:This case illustrates the effectiveness of pre-mapping in achieving safe reimplantation of a leadless pacemaker after TLE in complex CHD anatomy.

BACKGROUND:Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce. OBJECTIVE:This study aims to assess the efficacy and safety of PFA in patients with persistent AF. METHODS:Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected. RESULTS:The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87%), mitral isthmus ablation (37%), and cavo-tricuspid isthmus ablation (3%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69% vs. 56%, p = 0.013). While AF recurrence did not significantly differ (25% vs. 28%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8% vs. 22%, p < 0.001). Major complications occurred in 2.0% versus 1.0% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400). CONCLUSIONS:PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.

Pulsed field ablation (PFA) is increasingly gaining popularity for cardiac ablation. The 31/35 mm pentaspline PFA catheter is a single-shot device for pulmonary vein isolation (PVI). Remapping data of patients undergoing repeat procedures for recurrence of arrhythmia after PVI with the pentaspline catheter is sparse and so far, the durability of PVI does not seem to be superior to conventional thermal ablation technologies. We aimed to better understand the location of conduction gaps in reconnected pulmonary veins (PVs) after PVI with the pentaspline PFA catheter to potentially improve PVI durability in future. All repeat procedures of patients who underwent PVI with the pentaspline PFA catheter at our center between 2021 and 2024 were analyzed. Repeat procedures were performed with a 3D-electroanatomical mapping system and radiofrequency ablation. In case of PV reconnection, the site of the gap or the sites of multiple gaps were assessed if possible. Gap location was assigned to a quadrant (antero-superior, antero-inferior, postero-superior, postero-inferior) for each PV. We analyzed a total of 101 repeat procedures and 400 pulmonary veins including 4 left common PVs (LCPV). Of these, 268 PVs (67%) were initially treated with the 31 mm pentaspline catheter and 132 PVs (33%) with the 35 mm device. A reconnection was found in 67/400 (16.8%) of PVs. No statistically significant difference in reconnection rate was observed between the 31 mm and the 35 mm catheter. We were able to localize 58 conduction gaps (Figure 1). The most frequently reconnected PV was the right inferior pulmonary vein (RIPV) with 21/100 PVs, while the LCPV had the highest rate of reconnection (2 of 4 PVs). The most common conduction gap site was at the antero-inferior aspect of the RIPV (12 gaps). To the best of our knowledge, we present the largest analysis of conduction gap sites after pulmonary vein isolation with the pentaspline PFA catheter to date. Our analysis shows the most prevalent gap at the antero-inferior aspect of the RIPV, where the short distance between the transseptal puncture site and the PV ostium may handicap catheter manipulation and lead to poor catheter-tissue contact. Awareness of this fact may aid in improving PVI durability.Sites of conduction gaps

It has been reported that pulmonary vein stumps after lung lobectomy can act as triggers for atrial fibrillation. These two cases represent the first report of successful pulmonary vein isolation by pulsed field ablation using the pentaspline catheter after pulmonary lobectomy under intracardiac echocardiography guidance.

Treating atrial tachycardia (AT) originating from left atrial appendage (LAA) needs sometimes electrical isolation of LAA. We report a case of AT originating from LAA successfully treated with electrical isolation using the novel lattice-tip pulsed-field/radiofrequency ablation (PFA/RFA) catheter. A 55-year-old female patient with a history of three focal ablative attempts for a highly symptomatic AT originating from the LAA in different centers was admitted to our department for the recurrence of the clinical tachycardia. Electrical isolation of the LAA (LAAEI) was successfully performed with a lattice-tip PFA/RFA ablation catheter. Six weeks after the procedure, an invasive re-mapping study indicated a durable electrical LAA isolation; therefore, a 24-mm-sized LAA occlusion device (WATCHMAN FLX device, Boston Scientific, Plymouth, MN, USA) was implanted. In this case, we successfully treated an atrial tachycardia originating from LAA using the recently approved lattice-tip PFA/RFA ablation catheter. The combination between two energy sources during the same procedure could potentially improve lesions transmurality offering a new promising solution for the treatment of complex atrial tachycardias. Left atrial appendage electrical isolation using the novel lattice-tip PFA/RFA catheter. Purple signals were recorded using a spiral mapping catheter positioned in LAA. White signals were recorded from the 9-electrodes-Lattice-tip ablation catheter. Green signals are recorded from a deflectable multipolar catheter positioned in coronary sinus.

Catheter ablation of atrial fibrillation using non-thermal electroporation represents a promising ablation modality due to its believed superior safety profile. Still, if electroporation is delivered in proximity to a coronary artery, vasospasms can occur. We report the first case of severe right coronary artery vasospasm resulting in ST-segment elevation and AV block despite a remote distance from the ablation site to the right coronary artery, indicating a different mechanism. In this case, electroporation most likely triggered a previously unknown Prinzmetal vasospastic angina in the patient, resulting in the coronary vasospasm. Thus, meticulous monitoring of ST-segment changes following PFA delivery even from regions remote to coronary arteries is required.

BACKGROUND:A novel lattice tip ablation catheter that can toggle between radiofrequency and pulsed-field energy is able to perform not only pulmonary vein isolation, but also linear lesions under general anesthesia (GA). OBJECTIVE:We aimed to evaluate the concerns associated with the use of deep sedation and the clinical data related to linear ablation. METHODS:Clinical data from two Germany high-volume atrial fibrillation (AF) centers were collected. The objectives of this study are to confirm the feasibility and safety of linear lesion ablation using the lattice tip catheter without GA. Acute procedural and short-term follow-up data were collected. RESULTS:This study included 55 patients who underwent AF ablation (15 with GA vs 40 with deep sedation) including linear lesion ablation for atrial tachyarrhythmia using a lattice tip catheter. Bidirectional block of linear lesions was achieved in 21 of 21 linear lesions in the GA and in 74 of 76 (97%) linear lesions in the deep sedation group (P = 1.000) including roof line in 41 of 41 (100%), posterior wall isolation in 4 of 4 (100%), anterior mitral isthmus (MI) line in 5 of 5 (100%) vs 24 of 25 (96%), posterior MI line in 1 of 1 (100%) vs 4 of 5 (80%), cavotricuspid isthmus line in 15 of 15 (100%), and 1 left atrial appendage isolation. The overall incidence rate of complications was 1.8% (1 cardiac tamponade). There was no other procedural related complication. CONCLUSION:This preliminary clinical study demonstrates feasibility and safety of bidirectional block of linear lesions using a lattice tip catheter under deep sedation. Need to toggle between energy sources was low.

Aims Technological advancements have contributed to the enhanced precision and lesion flexibility in pulsed-field ablation (PFA) by integrating a three-dimensional mapping system combined with a point-by-point ablation strategy. Data regarding the feasibility of this technology remain limited to some clinical trials. This study aims to elucidate initial real-world data on catheter ablation utilizing a lattice-tip focal PFA/radiofrequency ablation (RFA) catheter in patients with persistent atrial fibrillation (AF).Methods and results Consecutive patients who underwent catheter ablation for persistent AF via the lattice-tip PFA/RFA catheter were enrolled. We evaluated acute procedural data including periprocedural data as well as the clinical follow-up within a 90-day blanking period. In total, 28 patients with persistent AF underwent AF ablation either under general anaesthesia (n = 6) or deep sedation (n = 22). In all patients, pulmonary vein isolation was successfully achieved. Additional linear ablations were conducted in 21 patients (78%) with a combination of successful anterior line (n = 13, 46%) and roof line (n = 19, 68%). The median procedural and fluoroscopic times were 97 (interquartile range, IQR: 80-114) min and 8.5 (IQR: 7.2-9.5) min, respectively. A total of 27 patients (96%) were interviewed during the follow-up within the blanking period, and early recurrent AF was documented in four patients (15%) including one case of recurrent AF during the hospital stay. Neither major nor minor procedural complication occurred.Conclusion In terms of real-world data, our data confirmed AF ablation feasibility utilizing the lattice-tip focal PFA/RFA catheter in patients with persistent AF. Graphical Abstract

A novel irrigated radiofrequency balloon (RFB) for pulmonary vein isolation (PVI) integrated into a 3D mapping platform was recently launched. Patients undergoing a first atrial fibrillation (AF) ablation at two German high-volume EP centers were included into the prospective AURORA registry. All patients underwent clinical follow-up (FU) at 90, 180, and 360 days following ablation including 48-h Holter ECGs. A total of 99 patients were enrolled (43/99 (43.4

AbstractBackgroundLaser balloon (LB) pulmonary vein isolation (PVI) is an established ablation technique for atrial fibrillation (AF). We report long‐term follow‐up and procedural data of LB‐PVI and we compare the first and second LB generation.MethodsPatients undergoing LB ablation with first‐ (LB1) or second‐generation LB (LB2) for AF were retrospectively enrolled and divided into two groups. Procedural endpoint was complete PVI. Clinical success was defined as no recurrence of AF/atrial tachycardia after a 90 days blanking period.Results538 patients were included (age 66 ± 10 years, 58% paroxysmal AF), 427 in LB1 and 111 in LB2. 2079 PVs were targeted and 2073 (99.7%) were successfully isolated; 2027 (97.5%) using solely the LB. Additional touch‐up ablation was limited (46 PVs; 2.2%) with no difference between the groups. Procedural (LB1: 120 ± 33 minutes vs. LB2: 99 ± 22 min; p < .001) and fluoroscopy time (LB1: 11.2 ± 5 min vs. LB2: 8.5 ± 3 min; p < .001) were shorter with LB2. The complication rate was 8.9% (LB1: 10.1% vs. LB2: 4.5%; p = .067) with most complications resulting from the access site (21/48). Overall freedom from AF after 1‐year was 73.7% (paroxysmal AF: 76.9%; persistent AF: 69.3%; p < .001) with no difference between the groups (LB1: 73.4% vs. LB2: 74.7%; p = .491).ConclusionLB showed a high efficacy and acceptable safety, with numerically lower complication rates with the second‐generation LB. Procedure and fluoroscopy times were shorter with LB2. Overall, 73.7% of patients were free from AF at 1‐year, with comparable results among both generations.

Aims A novel three-dimensional mapping platform combined with a lattice-tip catheter that can toggle between monopolar pulsed field ablation (PFA) and radiofrequency energy delivery was recently launched. So far, the system was predominantly applied in general anaesthesia (GA), not in deep sedation. Methods and results Patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) were enrolled, and pulmonary vein isolation (PVI) and ablation of additional linear lesion sets were performed either in GA or in deep sedation. Pulsed field ablation was applied exclusively to perform ipsilateral PVI. A total of 63 patients (35% female, 75% persistent AF, mean age 64 +/- 9 years) were included in the analysis with 23 patients treated in GA and 40 patients in deep sedation. Acute efficacy was comparable in both groups with a PVI rate of 100%. Additional 74 lesion sets were performed in the total cohort. Mean procedure and lab occupancy time in the GA and deep sedation group was 96 +/- 24 min vs. 100 +/- 23 min (P = 0.52) and 165 +/- 40 min vs. 131 +/- 35 min (P = 0.0008). Mean dose area product was 489 (216;1093) vs. 452 (272;882) cGycm(2) in the GA and the deep sedation group (P = 0.82). There was one conversion from deep sedation to GA. There were no map shifts observed in any group. Pericardial tamponade occurred in one patient of the deep sedation group. Conclusion The use of a novel ablation platform in conjunction with a lattice-tip catheter in deep sedation is feasible, effective, and associated with significantly shorter lab occupancy time when compared with GA.

We present the case of a 60-year-old male patient who was admitted to our hospital after experiencing a syncopal episode. First ECGs showed sinus rhythm with polymorphic premature ventricular complexes and later ventricular tachycardia with a left bundle branch block morphology were recorded. Imaging with TEE and MRI revealed a space-occupying lesion in the left ventricle, which was ultimately identified as a rare cardiac metastasis of renal cell carcinoma. Treatment was initiated with monoclonal antibodies resulting in lesion regression. This case highlights the importance of comprehensive diagnostic in patients with history of malignancy.