BACKGROUND:Scar-related atrial flutter (AFL) comprises complex reentrant atrial arrhythmias arising from areas of slow conduction typically in the setting of previous ablation, cardiac surgery, or atrial cardiomyopathy. 3-dimensional electroanatomic mapping is essential to define these complex circuits. OBJECTIVE:This study evaluated the feasibility of mapping and ablation of AFL using the Affera mapping and ablation system. METHODS:This single-center retrospective study included consecutive patients who underwent high-density mapping and catheter ablation of scar-related AFL using the Sphere-9 catheter and Prism-1 software. The primary efficacy outcome was defined as termination of the AFL at the initial ablation site or within the surrounding area. Secondary efficacy outcomes were termination of AFL with ablation at any site and AFL recurrence on/off antiarrhythmic drugs during follow-up. RESULTS:A total of 65 patients were included. Most patients had undergone ≥1 previous atrial fibrillation ablation procedure (87.7%). Median mapping time was 8 minutes (6-10), with a median number of points acquired on activation maps of 835 (510-1175) for the right atrium and 1859 (1418-2531) for the left atrium. Termination of the clinical AFL at the initial ablation site or surrounding area was achieved in 79.4% of patients. Termination of AFL with ablation at any site was achieved in all patients. During a median follow-up of 69 days (49-116), AFL recurrence occurred in 15% of patients. CONCLUSION:The study results demonstrate the feasibility of the Affera 3-dimensional electroanatomic mapping system to successfully map and ablate scar-related AFLs.

Abstract Background Electrical isolation of the left atrial appendage (LAA) has been shown to reduce arrhythmic recurrence in patients with long standing atrial fibrillation (AF); however, durable isolation remains a challenge. Purpose to demonstrate acute e chronic feasibility of LAA isolation in persistent AF patients with a focal ablation catheter toggling between radiofrequency (RF) and pulsed field energy (PFA). Methods We prospectively enrolled consecutive patients undergoing first-time persistent AF ablation with the lattice-tip PFA catheter between November 2024 and September 2025. Patients were divided int three groups according to the LAA ablation strategy at the ostium: 1) PFA 4 seconds only, (2) RF for 5seconds, 70% power, and (3) RF for 7 seconds, 90% power. The acute feasibility endpoint was LAA isolation defined as entrance and exit block after a 20-minute waiting period. Chronic feasibility was assessed as persistent LAA isolation during the LAAO procedure 3 months post-ablation. Results A total of 182 (113, 62% males) patients were included in the analysis. A total of 78 (42.8%), 43 (23.7%), and 61 (33.5%) patients were included to Groups 1, 2, and 3, respectively. All received PFA within the LAA body. Acute LAA isolation was achieved in all (100%) in both groups. All patients underwent repeat mapping during LAA closure after 3 months. LAA reconnection was observed in 78 (100%)patients in Group 1, 35(81.4%) in Group 2, and and none (0%) in Group 3 (p<0.001). Conclusion Acute LAA isolation with the lattice-tip PFA catheter was feasible across all strategies. However, in this cohort, PFA alone did not provide durable isolation, indicating that additional RF energy appears necessary to achieve chronic LAA isolation.

BACKGROUND:Pentaspline pulsed field ablation (PFA) is an emerging technology delivering ultra-short bursts of ablative high electrical field energy. There are limited studies on atrial fibrillation (AF) ablation safety using PFA in real-world experience in the United States. OBJECTIVES:The study sought to evaluate safety in patients who underwent AF ablation with a pentaspline PFA catheter in a multicenter registry. METHODS:Patients from the prospective, multicenter, nonrandomized, rigorously monitored, real-world DISRUPT-AF (A registry Based Collaborative To Measure Efficiency, Effectiveness, and Safety of Farapulse PFA Technology for AF) registry (NCT06335082), who underwent first-time AF ablation via PFA using the pentaspline catheter, from April 2024 to May 2025, across 20 centers in the United States, encompassing 77 operators, were included. Baseline characteristics and acute procedural safety outcomes were collected at 1- and 3-month follow-up based on the investigator's arm: acute, symptomatic monitoring only, or full monitoring. The primary safety outcome comprised procedure/device-related adverse events (AEs) after 1 and 3 months. Risk-adjusted analyses were conducted to assess AE predictors. RESULTS:A total of 1,576 patients were included: the mean age was 68.0 ± 11.4 years, 38.6% were female, and mean body mass index was 31.5 ± 7.0 kg/m2. At 3-month follow-up, AEs occurred in 2.2% of patients, with 1.6% classified as procedure/device related. The most common AEs were vascular access complications (pseudoaneurysm, 0.4%; hematoma, 0.3%), pericarditis (0.2%), and other nonspecific events (eg, hypotension 0.4%). Major procedure/device-related AEs occurred in 0.7% of patients and included stroke (0.3%), cardiac tamponade (0.1%), vascular injury requiring intervention (0.1%), and bleeding (0.1%). There were no cases of esophageal injury, persistent phrenic nerve injury, or pulmonary vein stenosis. There was 1 (0.06%) case reported as coronary vasospasm, and acute kidney injury was not observed. The 3-month all-cause mortality rate was 0.3%. In exploratory multivariable analyses, no associations were detected between clinical covariates and procedure/device-related AEs. CONCLUSIONS:In this multicenter, prospective U.S. registry, PFA demonstrated a low rate of procedure/device-related AEs. The absence of injury to the esophagus, phrenic nerve, and pulmonary veins highlights a tissue-selective profile that may represent a meaningful safety advantage over traditional thermal ablation, pending further direct comparisons.

Abstract Background Pulmonary vein isolation (PVI) alone is known to be not adequate to achieve long-term sinus rhythm in patients with persistent atrial fibrillation (PerAF). Thus, several adjunctive strategies have been tried. Purpose We compared the long-term outcome of PVI + Vein of Marshall alcohol ablation (VoM) vs PVI+ left atrial posterior wall isolation (LAPWI) using pulsed-field energy. Methods This prospective study included consecutive PerAF patients receiving PVI+VoM (group 1) that were propensity score-matched (1: 2.5) with consecutive PerAF patients undergoing pulsed-field ablation (PFA) for PVI+ LAPWI (group 2). It was the first ablation procedure for all. PVI was performed using PFA in both groups. Group 2 received additional PFA-based LAPWI. In group 1, VoM was achieved after cannulating the vein with an angioplasty wire and balloon and delivering 1 cc of 98% ethanol over 2 minutes. VoM ablation was performed prior to catheter ablation. Patients were monitored quarterly with office visits, 7-day Holter, wearable devices such as Apple watch or Kardia and regular self-pulse-checks. Results A total of 84 and 210 matched perAF patients were included in group 1 and 2 respectively. Baseline characteristics of the study population is given in table 1. Patients were followed-up for at least 2 years. At the end of the follow-up, 41 (48.8%) patients from the VoM group and 142 (67.6%) from the LAPWI group remained arrhythmia-free off-antiarrhythmic drugs (p=0.003) (figure 1). Multivariable regression analysis demonstrated VoM alcohol ablation to be a predictor of recurrence (OR = 2.190; 95% CI 1.307 – 3.670; p-value = 0.004) Conclusion In PerAF patients undergoing their first ablation procedure, PFA-based adjunctive LAPWI was demonstrated to have significantly better long-term outcome compared to the vein of Marshall alcohol ablation.