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Comparative Study
. 2024 Nov 1;26(11):euae270.
doi: 10.1093/europace/euae270.

General anaesthesia and deep sedation for monopolar pulsed field ablation using a lattice-tip catheter combined with a novel three-dimensional mapping system

Andreas Rillig  1 , Jun Hirokami  2   3 , Fabian Moser  1 , Stefano Bordignon  2   3 , Laura Rottner  1 , Tohoku Shota  2   3 , Ilaria My  1 , Andrea Urbani  2   3 , Marc Lemoine  1 , Joseph Kheir  2   3 , Niklas Schenker  1 , Lukas Urbanek  2   3 , Katarina Govorov  1 , David Schaack  2   3 , Julius Obergassel  1 , Jan Riess  1 , Djemail Ismaili  1 , Paulus Kirchhof  1 , Feifan Ouyang  1 , Boris Schmidt  2   3 , Bruno Reissmann  1 , Kyoung-Ryul Julian Chun  2   3 , Andreas Metzner  1
Affiliations
Comparative Study

General anaesthesia and deep sedation for monopolar pulsed field ablation using a lattice-tip catheter combined with a novel three-dimensional mapping system

Andreas Rillig et al. Europace. .

Abstract

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) cGycm2 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.

Keywords: 3D mapping; Anaesthesia; Atrial fibrillation ablation; Deep sedation; General anaesthesia; Lattice tip; Monopolar; Pulsed field ablation.

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Conflict of interest statement

Conflict of interest: B.S. is a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. S.B. has received honoraria from Medtronic and Biosense Webster. K.R.J.C. is a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. A.M. is a consultant for and has received honoraria from Abbott, Medtronic, Boston Scientific, and Biosense Webster. A.R. has received travel grants or lecture fees from Medtronic, Ablacon, Abbott, Boston Scientific, Biosense Webster, Pfizer, LifeTech, Bayer, AtriCure, and Novartis. All other authors have nothing to disclose. P.K. was partially supported by European Union MAESTRIA (grant agreement 965286), British Heart Foundation (AA/18/2/34218), German Center for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, grant numbers DZHK FKZ 81X2800182, 81Z0710116, and 81Z0710110), German Research Foundation (Ki 509167694), and Leducq Foundation. P.K. received research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Center for Cardiovascular Research, from several drug and device companies active in atrial fibrillation, and has received honoraria from several such companies in the past, but not in the last five years. P.K. is listed as inventor on two issued patents held by University of Hamburg (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783).

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
The novel lattice-tip catheter with a diameter of 9 mm with nine mini-electrodes at its surface and a central electrode. The catheter is bidirectionally steerable and can toggle between pulsed field and RF ablation.
Figure 2
Figure 2
Three-dimensional bipolar map of the LA and the right- and left-sided PVs in a posterior–anterior and a left lateral projection. The green dots mark PFA-based lesions around the ipsilateral PVs as applied by the lattice-tip mapping and ablation catheter.
See this image and copyright information in PMC

References

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