Background:Pulsed field ablation is an established energy source for catheter ablation (CA) of arrhythmias. Recently, a novel balloon-in-basket pulsed field ablation (BiBPFA) catheter has been introduced; however, its use beyond pulmonary vein isolation (PVI) has not yet been studied. Objective:This study aimed to demonstrate the feasibility of versatile CA of atrial fibrillation, atrial flutter (AFL), and atrial tachycardia (AT) using the novel BiBPFA catheter. Methods:Consecutive patients undergoing CA, including index and repeat procedures, using the novel BiBPFA catheter in a single center from June 2025 to March 2026 were analyzed. CA involved PVI/re-PVI, cavotricuspid isthmus ablation, and left atrial substrate modification, including anterior lines, roof lines, posterior wall isolation, and focal ablation. Endpoints included acute procedural success and procedural safety. Results:A total of 42 patients were included (age 68.4 ± 9.7 years; CHA2DS2-VA score 2.4 ± 1.4; 77.8% males; 64.3% persistent atrial fibrillation; 16.7% with AFL; 9.5% with AT) in this study. CA included the isolation/reisolation of 231 pulmonary veins (14.4 ± 3.3 applications), 7 cavotricuspid isthmus ablations (10.6 ± 8.1 applications), and left atrial substrate modification, including 1 anterior line (12 applications), 6 roof lines (6 ± 1.6 applications), 9 posterior wall isolations (15.3 ± 6), and 1 focal ablation (8 applications). Acute procedural success was achieved in all 42 patients (100%). No procedural complications occurred. Conclusion:Initial experience with the novel BiBPFA catheter suggests broad procedural versatility beyond PVI, enabling effective mapping and ablation of ATs and right AFL and atrial substrate modification using a single-device approach.

Background:Pulsed field ablation (PFA) with a circular-electrode-array catheter (cPFA) has shown to be effective and safe. However, data on procedural workflow are limited. Objective:to analyze the process of streamlining cPFA-procedures including evaluation of fluoroscopy versus 3D-map guidance and lesion characteristics. Methods:Consecutive AF-patients underwent cPFA-based pulmonary vein isolation (PVI) in three phases (learning-phase-I: visualization of cPFA in 3D-map; phase-II: operator blinded to 3D-map with fluoroscopy-guidance only; phase-III: optimized mapping and ablation). Additionally, hemolysis-parameters were collected. Results:A total of 35 patients (57 % paroxysmal-AF, age 63.4 ± 9.4 years) were enrolled: n = 10 phase-I, n = 15 phase-II, n = 10 in phase III. Total procedure and fluoroscopy time was 51.9 ± 9.4 and 6.7 ± 3.1 min, respectively. First-pass PFA isolation-rate was lowest in the fluoroscopy-only phase-II (I:86 %, II:81 %, III:100 %, p = 0.0079). Insufficient PV ablation with remaining conduction occurred mostly anterior (n = 8/15, 53 %) and at the carina (n = 4/15; 27 %). Following additional PFA, all 142 PVs (100 %) were acutely isolated.Procedure times between phase II and III did not differ (49 ± 8 vs. 46 ± 3 mins p = 0.23). Fluoroscopy times were longer in phase-II (phase-I: 5.8 ± 1.3, phase-II: 9.2 ± 2.9, phase-III: 3.8 ± 1.0 mins, p < 0.0001). No complications occurred. Pre- and post-ablation hemoglobin (14.4 ± 1.4 vs. 13.5 ± 1.2 g/dl, p = 0.0169) and LDH (188 ± 39 vs. 210 ± 29 U/l, p = 0.0007) were different. Conclusion:The cPFA-catheter allows for fast and efficient PVI. A fluoroscopy-only approach creates distal PV ablation lesions that are associated with residual PV conduction along the carina and anterior antrum. However, with visualization and mapping, creation of wide antral ablation lesions is feasible without prolonging procedural duration.

In patients with ventricular arrhythmias (VA) admitted via the emergency department (ED), immediate catheter ablation (CA-VA) might be indicated to stabilize patients. However, the unstable condition of these patients may increase periprocedural risk. This study evaluated the periprocedural safety of immediate CA-VA in patients admitted via the ED. In total, 223 ED patients who underwent immediate CA-VA from 01/2017 to 12/2022 (mean age 66 ± 13 years, 19

ABSTRACT Background Catheter ablation (CA) for atrial fibrillation (AF) in the elderly poses a growing challenge. Outcome data regarding CA in these patients are scarce. Methods Octogenarians with AF or consecutive atrial tachycardia undergoing index or re‐ablation (pulmonary vein isolation [PVI] and ablation beyond PVI with different energy sources) in a single center, were analyzed. Study endpoints were efficacy as well as procedural safety. Secondary endpoints included periprocedural complications and predictors for prolonged hospital stay. Results In total, 301 patients (82.1 ± 1.9 years, paroxysmal AF n = 94 [31.2%], CHA 2 DS 2 ‐VASc‐Score 4.2 ± 1.2) undergoing index ablation ( n = 172/301, 57.1% [PVI only n = 156/172, radiofrequency n = 92, cryoballoon n = 59, pulsed‐field ablation n = 5]) and re‐ablation ( n = 129/301 [42.9%]) were included. Arrhythmia‐free survival at 1 year was 72.6%. Complication rates were low (groin site n = 2/301 [0.7%], tamponade n = 2/301 [0.7%] and stroke n = 1/301 [0.3%]). However concomitant infections (pneumonia n = 5/301 [1.7%], urinary‐tract‐infections n = 4/301, [1.3%]) and pacemaker‐implantation n = 6/301 (2%) occurred more commonly. Hospital stay after CA was 2.3 ± 2 nights. Predictors for prolonged hospitalization were complications (odds ratio: 3.1), infections (odds ratio: 2.1), female sex (odds ratio: 1.15) and frailty assessed by Barthel index (odds ratio: 1.02). Conclusions CA for AF in octogenarians shows low procedural complications and reasonable efficacy. However, concomitant infections and pacemaker implantations occur in this cohort. Due to prolonged hospitalization after CA, especially in female and frail octogenarians, same‐day discharge may not be suitable for this specific patient cohort.

AIMS:Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT. METHODS AND RESULTS:Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P < 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11-7.65), P = 0.0473]. CONCLUSION:Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.

Abstract Background Pulsed field ablation (PFA) has emerged as a novel technology that is increasingly applied for the catheter ablation (CA) of atrial fibrillation (AF) with similar efficacy to established, thermal energy sources. Data solely focussing on analgosedation compared to established single-shot modalities, such as cryoballoon (CB) ablation are scarce. Aim The aim of this study was to assess differences of analgosedation requirement, procedural cardiopulmonary stability, and analgosedation-associated complications between PFA and CB ablation. Methods This study was a retrospective single-centre comparison of analgosedation in patients with paroxysmal, persistent, and long-standing persistent AF undergoing pulmonary vein isolation (PVI) with either PFA or CB from March 2021 until April 2022. The primary study endpoints were the requirements of analgosedation medications (propofol, midazolam and sufentanyl), cardiorespiratory stability measured as decreases in oxygen saturation and systolic blood pressure and analgosedation-associated complications. Secondary endpoints were acute procedural success, procedure time and overall complication rates. Results A total of 100 patients were included {PFA n=50, CB n=50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). The body weight – and procedure time-adjusted requirement of all analgosedation medications was significantly higher in the PFA group compared to CB {Propofol 0.14 ± 0.04 mg/kg/min in PFA versus 0.11 ± 0.04 mg/kg/min in CB (p=0.001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA versus 0.00063 ± 0.0003 mg/kg/min in CB (p=0.002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA versus 0.0008 ± 0.0004 µg/kg/min in CB (p<0.0001)}. Procedural cardiorespiratory stability did not differ between groups (maximum blood pressure decrease PFA 53.4 ± 20.9 mmHg, CB 50.3 ± 18.6 mmHg, P=0.28 and maximum decrease in oxygen saturation: PFA group 4.8 ± 5.3 %, CB group 3.5 ± 2.6 %, P=0.12). Analgosedation-associated complications did not differ between both groups (PFA n=1/50 mild aspiration pneumonia, CB n=0/50, p=0.99). There was no significant difference in acute procedural success (100% n=50/50 in both groups, p>0.99), non-analgosedation associated complications (PFA: n=2/50, 4%, CB: n=1/50, 2%, p=0.99) and procedure times (PFA 75 ± 31, CB 84 ± 32 mins, p=0.18) between groups. Conclusions Pulsed field ablation is associated with higher sedation and especially analgesia requirement compared to cryoballoon ablation, however, the safety of analgosedation does not differ significantly to cryoballoon ablation.

Abstract Background Catheter ablation for atrial fibrillation (AF) in octogenarians poses a challenge due to comorbidities, frailty, and suspected higher complication rates. Data regarding the outcome of catheter ablation in this population is scarce. Purpose Due to the projected increase of octogenarians presenting with AF in the future, we investigated the outcome of catheter ablation in this patient population. Methods We retrospectively analysed octogenarians with symptomatic AF undergoing catheter ablation in a single centre, including first and re-ablation procedures. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency (RF), cryoballoon (CB) and pulsed field ablation (PFA) as energy sources and also atrial tachycardia (AT) ablation including linear lesions and/or ablation of complex fractionated atrial electrograms (CFAE). Follow-up (FU) was obtained to assess arrhythmia-free survival after a 90-day blanking period, recurrences after the blanking period, management of recurrences, rhythm at FU, use of antiarrhythmic drugs (AADs) and improvement in symptoms (EHRA symptom scale). Results A total of 126 patients (mean age 82.2 ± 1.9 years, paroxysmal AF n=48, persistent AF n=78, mean CHA2DS2-VASc-Score 4.2 ± 1.5) were included. 57.1% (n=72/126) underwent an index procedure {47.2% (n=34/72) RF PVI, 37.5% (n=27/72) CB PVI, 4.2% (n=3/72) PFA PVI and 11.1% (n=8/72) PVI + AT ablation}. 42.9% (n=54/126) received repeat procedures {20.4% (n=11/54) re-PVI, 42.6% (n=23/54) re-PVI + AT ablation, 37% (n=20/54) AT ablation}. FU of 108 patients after 15.4 ± 3.6 months revealed arrhythmia-free survival after the blanking period in 64.8% (n=70/108). Recurrence after the blanking period was seen in 35.2% (n=38/108). No significant difference in recurrences was shown between index and repeat procedures (32.3%, n=20/62 after index procedures and 36.7%, n=18/49 after repeat procedures, p =0.97). Management of recurrence involved repeat ablation (47%, n=18/38), AADs (16%, n=6/38), cardioversion (21%, n=8/38), pacemaker-implantation/AV-node ablation (5%, n=2/38) and pharmacological rate control (11%, n=4/38). At FU, 88.9% (n=96/108) of patients were in sinus rhythm with 21.3% (n=23/108) receiving AADs, 7.4% (n=8/108) were in AF, 0.9% (n=1/108) in AT and 2.8% (n=3/108) pacemaker-dependant. Symptoms were significantly improved at FU (mean EHRA score at FU= 1.2 ± 0.5, before ablation= 2.4 ± 0.5, p <0.0001). Conclusion Catheter ablation for AF in octogenarians is effective in maintaining sinus rhythm and controlling AF-related symptoms. Longer term success and impact on prognosis in this patient population is unknown and should be investigated further.

Severe injuries of the esophagus causing major complications after catheter ablation (CA) of atrial fibrillation are rare. However, endoscopically detected esophageal lesions (EDEL) have been described in up to 30% after radiofrequency current energy ablation. The novel non-thermal ablation technology pulsed field ablation (PFA) allows for unique ablation of the myocardium, sparing adjacent tissues, including the esophagus.

Background: Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. Objective: This study aimed to investigate the efficacy and safety of LAPWI performed by non-thermal pulsed field ablation (PFA) in CA for persAF. Methods: Consecutive persAF patients from two German centers were prospectively enrolled. There were two study cohorts: (1) the LAPWI cohort, which included PFA-guided (re-)PVI with LAPWI for first-time and/or repeat ablation procedures; and (2) a comparative persAF cohort with a PFA PVI-only approach without LAPWI for first-time ablation within the same timeframe. Patients were followed up by routine Holter ECGs. Results: In total, 79 persistent AF patients were included in the study: 59/79 patients were enrolled in the LAPWI cohort, including 16/59 index (27%) and 43/59 repeat ablation procedures (73%). Sixteen patients (16/79; 21%) were in the PVI-only cohort without LAPWI. Of the patients treated with LAPWI, procedure time and fluoroscopy time was 91 ± 30 min and 15 ± 7 min, respectively. The acute PVI rate was 100% in all first-time ablation patients (32 patients (16 PVI only, 16 PVI plus LAPWI), 196/196 PVs). Of the 43 re-do patients in the LAPWI cohort, re-PVI was necessary in 33% (14/43) of patients (27 PVs; 1.9 PV per-patient); in 67% (29/43), all PVs were isolated, and antral ablation of the PV ostia was performed in 48% (14/29). LAPWI was performed successfully in all 59 (100%) patients of the LAPWI cohort. Two minor complications occurred. No esophageal lesion was detected in the LAPWI cohort (n = 33/59 (56%) patients underwent endoscopy). After 354 ± 197 days of follow-up, freedom from atrial arrhythmias was 79.3% (95-CI: 62–95%) in the complete LAPWI cohort (n = 14/59 (24%) on AAD: class Ic n = 9, class III n = 5). There was no difference regarding acute procedural and clinical outcome compared to the PVI-only cohort. Conclusion: LAPWI guided by PFA is feasible and safe in patients undergoing CA for persAF and shows favorable outcomes. In the context of durable PVI, PFA-guided LAPWI may be an effective adjunctive treatment option.

Catheter-ablation (CA) of consecutive left atrial tachycardias (LAT) can be challenging. Pulsed field ablation (PFA) yields a novel non-thermal CA technology for treatment of atrial fibrillation (AF). There is no data regarding PFA of LAT.

Pulsed field ablation (PFA) has recently been introduced as a novel ablation technology for atrial fibrillation (AF). However, data on long-term procedural outcome are sparse. To investigate acute and chronic procedural success and safety in patients undergoing PFA for the treatment of AF. Consecutive paroxysmal and persistent AF patients underwent PFA-based catheter ablation using a multi-spline catheter. PFA-based ablation procedures, including first and repeat ablation procedures, were performed with additional 3D electroanatomical mapping. Procedural parameters, acute success, safety and long-term outcome were assessed. Follow up was conducted by telephone interview, routine Holter-ECGs and control of implantable cardiac devices, if applicable. A total of 101 patients undergoing PFA from May 2021 until November 2022 in one German center were included in the study. Patients suffered from paroxysmal AF (n= 38; 38%), persistent AF (n=36; 36%) and consecutive atrial tachycardias (AT) due to previous catheter ablation (n=27; 26%). Mean age was 67 ± 14 years, median CHA2DS2-VASc Score was 2 (Q1-Q3: 1-3), mean left atrial diameter was 44 ± 9 mm and 83 of 101 (82%) patients had a normal left ventricular ejection fraction. Of all PFA procedures, 61 (60%) were index ablation procedures and 40 (40%) were repeat procedures (including re-pulmonary vein isolation and/or left posterior wall isolation and/or conduction of roof, anterior and/or mitral isthmus lines). The median total procedure and left atrial (LA) PFA times were 98 (Q1-Q3: 61-121) and 34 (Q1-Q3: 24-47) minutes, respectively. Mean total fluoroscopy and LA PFA fluoroscopy times were 14 ± 7 and 9 ± 5 minutes. Successful PFA lesions were created in 100/101 patients (99%). In one patient, the use of radiofrequency ablation in the coronary sinus was needed to block the mitral isthmus line. Total complication rate was 7.9% (8/101) including only one major complication (n=1 pericardial tamponade; 0,99%). Minor complications were found in 7 patients (1 coronary spasm without sequela, 2 minor groin AV fistulas, 1 cardiac decompensation, 1 transient intra-procedural AV-block, 1 aspiration, 1 macro hematuria). Preliminary follow up of 264 ± 138 days including 63 patients showed 83% freedom from arrhythmias (52/63 patients without recurrence). In this initial experience, PFA applied in patients with atrial fibrillation demonstrates high chronic procedural success rates and a favorable safety profile.

INTRODUCTION:Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single-shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single-shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB. METHODS:Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective CB-PVI cohort of the same timeframe. Study endpoints were the requirements of analgesics, cardiorespiratory stability, and sedation-associated complications. RESULTS:A total of 100 PVI patients were included (PFA n = 50, CB n = 50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). Requirement of propofol, midazolam, and sufentanyl was significantly higher in the PFA group compared to CB [propofol 0.14 ± 0.04 mg/kg/min in PFA vs. 0.11 ± 0.04 mg/kg/min in CB (p = .001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA vs. 0.0006295 ± 0.0003 mg/kg/min in CB (p = .002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA vs. 0.0008 ± 0.0004 µg/kg/min in CB (p < .0001)]. Sedation-associated complications did not differ between both groups (PFA n = 1/50 mild aspiration pneumonia, CB n = 0/50, p > .99). Nonsedation-associated complications (PFA: n = 2/50, 4%, CB: n = 1/50, 2%, p > .99) and procedure times (PFA 75 ± 31, CB 84 ± 32 min, p = .18) did not differ between groups. CONCLUSIONS:PFA is associated with higher sedation and especially analgesia requirements. However, the safety of deep sedation does not differ to CB ablation.

INTRODUCTION:Catheter-ablation (CA) of consecutive left atrial tachycardias (LAT) can be challenging. Pulsed field ablation (PFA) yields a novel nonthermal CA technology for treatment of atrial fibrillation (AF). There is no data regarding PFA of LAT. This study sought to investigate PFA of consecutive LAT following prior CA of AF.METHODS:Consecutive patients with LAT underwent ultrahigh-density (UHDx) mapping. Subsequent to identification of the AT mechanism, PFA was performed at the assumed critical sites for LAT maintenance. Continuous ablation lines were performed if required and evaluated with pre- and post-PFA HDx-mapping.RESULTS:Fifteen patients (age 70 ± 10, male 73%) who underwent 3.6 ± 2 prior AF-CA procedures were included. The total mean procedure and fluoroscopy times were 141 ± 43 and 18 ± 10 min, respectively. All 19 of 19 (100%) LAT were successfully ablated with PFA. Two AT located at the right atria required RF-ablation. LAT were identified as localized reentry (n = 1) and macro-reentry LAT (n = 18) and targeted with PFA. All LAT terminated with PFA either to sinus rhythm (9/15) or a secondary AT (6/15 and subsequently to SR); 63% (12/19) terminated with the first PFA-application. All lines (13 roof, 11 anterior, 1 mitral) were blocked. LA-posterior-wall isolation (LAPWI) was successfully achieved when performed (10/10). AF/AT free survival was 80% (12/15) after 153 [88-207] days of follow-up. No procedure-related complications occurred.CONCLUSION:PFA of consecutive LAT is feasible and safe. Successful creation of ablation lines and LAPWI can be achieved in a short time. PFA may offer the opportunity for effective ablation of atrial arrhythmias beyond AF.

Abstract Background The incidence and prevalence of atrial fibrillation (AF) increases with age. With an ageing general population, a 2.3-fold rise in AF prevalence is expected. Catheter ablation has emerged as an effective treatment option for rhythm control therapy. However, very elderly patients (≥80 years old) have been excluded in landmark clinical trials. Current data regarding the safety and efficacy of catheter ablation in the very elderly is therefore sparse. Purpose Due to the growing demand to manage AF in an increasingly ageing population, we investigated the safety and efficacy of catheter ablation in this particular patient population. Methods Patients with symptomatic paroxysmal, persistent and long-standing persistent AF aged ≥80 years undergoing catheter ablation, including first and re-ablation procedures in a single centre, were analysed retrospectively. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency, cryoballoon and pulsed field ablation as energy sources. Re-ablation procedures included re-PVI and consecutive atrial tachycardia ablation including atrial lines and/or ablation of complex fractionated atrial electrograms (CFAE) in persistent AF. Endpoints included acute procedural success (complete isolation of pulmonary veins and/or non-inducibility in the case of atrial tachycardia), major complications and early arrhythmia-recurrence. Results A total of eighty-eight patients (mean age 83.1±1.9 years, mean CHA2DS2-VASc-Score 4.4±1, mean left ventricular ejection fraction 56.7±7%, direct oral anticoagulation 92.1%, vitamin-K antagonists 7.9%) were included from January 2021 to October 2021. Fifty cases (56.8%) involved PVI as an index procedure (radiofrequency 58%, n=29/50, cryoballoon 36%, n=18/50, pulsed field ablation 6%, n=3/50). Thirty-eight procedures (43.2%) involved re-ablation procedures (Re-PVI 60.5%, n=23/38, linear lesions 65.8%, n=25/38, atrial tachycardia ablation 26.3%, n=10/38 and ablation of CFAE 15.8%, n=6/38). Acute procedural success was achieved in 87/88 patients (98.9%). Major complications included stroke (n=1/88, 1.1%), pericardial tamponade (n=1/88, 1.1%) and bradycardia with subsequent pacemaker implantation (n=3/88, 3.4%). No further major complications were documented. In 13/88 patients (14.8%) early arrhythmia-recurrence occurred (38.5%, n=5/13 after the index procedure and 61.5%, n=8/13 after re-ablation) during the 90-day blanking period. Conclusions Catheter ablation for atrial fibrillation in the very elderly shows favourable acute success and low complication rates. Long term success of catheter ablation and superiority to rate control in this patient population is unknown and requires investigation in the future. Funding Acknowledgement Type of funding sources: None.

BACKGROUND:Pulsed-field ablation (PFA) yields a novel ablation technology for atrial fibrillation (AF). PFA lesions promise to be highly durable, however clinical data on lesion characteristics are still limited.OBJECTIVE:This study sought to investigate PFA lesion creation with ultrahigh-density (UHDx) mapping.METHODS:Consecutive AF patients underwent PFA-based pulmonary vein isolation (PVI) using a multispline catheter (Farwave, Farapulse Inc.). Additional ablation, including left atrial posterior wall isolation (LAPWI) and mitral isthmus ablation (MI) were performed in a subset of persistent AF patients. The extent of PFA-lesions and decrease of LA-voltage were assessed with pre- and post PFA UHDx-mapping (Orion™ catheter and Rhythmia™ 3D-mapping system, Boston Scientific).RESULTS:In 20 patients, acute PVI was achieved in 80/80 PVs, LAPW isolation in 9/9 patients, MI ablation in 2/2 (procedure time: 123 ± 21.6 min, fluoroscopy time: 19.2 ± 5.5 min). UHDx-mapping subsequent to PVI revealed early PV-reconnection in five case (5/80, 6.25%). Gaps were located at the anterior-superior PV ostia and were successfully targeted with additional PFA. Repeat UHDx mapping after PFA revealed a significant decrease of voltage along the PV ostia (1.67 ± 1.36 mV vs. 0.053 ± 0.038 mV, p < .0001) with almost no complex electrogram-fractionation at the lesion border zones. PFA-catheter visualization within the mapping system was feasible in 17/19 (84.9%) patients and adequate in 92.9% of ablation sites.CONCLUSION:For the first time illustrated by UHDx mapping, PFA creates wide antral circumferential lesions and homogenous LAPW isolation with depression of tissue voltage to a minimum. Although with a low incidence, early PV reconnection can still occur also in the setting of PFA.

INTRODUCTION:Recently, the wide-band dielectric mapping system Kodex-EPD was introduced. This study reports the first clinical experience using a novel system to guide pulmonary vein isolation (PVI) with radiofrequency (RF) ablation. METHODS AND RESULTS: The study included 20 consecutive patients undergoing de-novo PVI for symptomatic paroxysmal or persistent atrial fibrillation guided by Kodex-EPD. The primary efficacy endpoint was successful PVI. Secondary endpoints included procedural parameters and complications. In all 20 patients (mean age 68 ± 8 years, 12 male patients, paroxysmal fibrillation in 14/20 [70%] patients), PVI was successfully completed. One patient underwent additional cavo-tricuspid isthmus ablation for concomitant typical atrial flutter and one patient required additional ablation of a focal atrial tachycardia. A conventional three-dimensional image of the left atrium as well as the innovative endocardial panoramic view were used to guide catheter manipulation and ablation. Median procedure time was 115 [1st; 3rd quartile 93,75; 140] min and median total fluoroscopy time was 9.9 [9.7; 11.2] min, of which a median of 0.8 [0.6; 0.9] min was required to create left atrial maps. Complete left atrial imaging using Kodex-EPD was achieved within a median of 7.1 [5.7; 8.3] min. Median RF ablation time was 45.1 [34.6; 58.7] min. No major complications were observed.CONCLUSION:RF ablation PVI guided by Kodex-EPD seems safe and feasible. The system provides effective three-dimensional guidance for PVI.

Zusammenfassung Vorhofflimmern ist die weltweit haufigste, anhaltende Herzrhythmusstorung. Trotz des Fortschritts und der Innovationen im Management der betroffenen Patienten bleibt Vorhofflimmern mit einer signifikanten Morbiditat und Mortalitat, bedingt durch das Auftreten von unter anderem thrombembolischen Ereignissen, Herzinsuffizienz, kardiovaskularen Ereignissen und plotzlichem Herztod, vergesellschaftet. Es konnte kurzlich gezeigt werden, dass eine fruhzeitige rhythmuserhaltende Therapie das Risiko fur einen Tod durch kardiovaskulare Ursache, Schlaganfalle und Hospitalisierungen aufgrund von Herzinsuffizienz reduzieren kann. Die Katheterablation von Vorhofflimmern ist zwar effektiver in der Wiederherstellung und Erhaltung von Sinusrhythmus als eine medikamentose Therapie, aber lediglich in spezifischen Patientengruppen, die von Herzinsuffizienz und Vorhofflimmern betroffen sind, konnte die Ablationsbehandlung mit einer Reduktion der Gesamtmortalitat und von Hospitalisierungen assoziiert werden. Abstract Atrial fibrillation (AF) is the most common persistent arrhythmia worldwide. Despite progress and recent innovations in the management of affected patients, AF remains associated with significant morbidity and mortality such as thromboembolic events, heart failure, cardiovascular events and sudden cardiac death. Early rhythm-control therapy has recently been shown to reduce the risk for death from cardiovascular causes, stroke and hospitalization for heart failure. Though catheter ablation of AF is more effective in restoring and maintaining sinus rhythm than medical therapy, only in specific subgroups of patients with heart failure and AF, ablation could be linked with reduced all-cause mortality and hospitalizations for heart failure.