Arrhythmias & electrophysiology
Characterization of acute residual pulmonary vein connections using electroanatomic mapping during pulsed-field ablation of atrial fibrillation
Authors' conclusion
Using 3D-EAM, an acute residual connection of at least 1 PV was observed in a quarter of patients after standard PFA delivery and was most common in the left superior PV.
Study context
- Population
- Patients undergoing index pulmonary vein isolation (PVI) with a single-shot pulsed-field ablation (PFA) catheter and postablation 3D electroanatomic mapping
- Participants
- 535 patients · 48 centres
- Exposure
- Paroxysmal atrial fibrillation (AF) vs Persistent AF
- Paroxysmal AFn = 375
- Persistent AFn = 160
- Outcome
- First-pass isolation (FPI) rates and distribution of residual PV connections
Methodological detailsinternational
- International
Main finding
As reported in the abstract
Bilateral FPI
P = 0.126
- Bilateral first-pass isolation (FPI), all patients
- 75.1%
- Individual pulmonary vein (PV) FPI rate (1834 of 1978 PVs)
- 92.7%
Observational data: associations, not effects.
Further findings
Predictors of FPI
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| Standard 4-vein anatomy | 1.83 (1.09–3.07) | P = 0.021 | |
| Pentaspline catheter | 3.53 (1.81–6.87) | P < 0.001 | |
| 0.10.31310Odds ratio (log scale) |
Residual PV connections by PV location (excluding common PVs)
- Superior PVs
- 8.9%
- Inferior PVs
- 3.8%
- Superior vs inferior
- P < 0.001
- Left superior PV
- 10.1%
Procedure and mapping time
- Mean procedure time (minutes)
- 75.9 ± 31.9
- Mean mapping time (minutes)
- 8.4 ± 5.2
- Pentaspline, variable conformation PFA catheter
- 72.7%
- Fixed-loop PFA catheter
- 27.3%
Original publication
Characterization of acute residual pulmonary vein connections using electroanatomic mapping during pulsed-field ablation of atrial fibrillation. Heart Rhythm. Published 27 June 2025. doi:10.
Summarised from the published abstract; every number is checked against it