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Multicenter Study
. 2025 Sep 1;27(9):euaf139.
doi: 10.1093/europace/euaf139.

Safety and efficacy of a lattice-tip catheter for ventricular arrhythmia ablation: the AFFERA Ventricular Arrhythmia Ablation Registry (AVAAR)

Frédéric Sacher  1 , Andrea Sarkozy  2 , Helmut Pürerfellner  3 , Alexandra Steyer  4 , Jonathan Lyne  5 , Charlène Coquard  6 , Romain Tixier  1 , Nicolas Combes  7 , Michel Haissaguerre  1 , Michalis Efremidis  8 , Josselin Duchateau  1 , Victor Castro Urda  9 , Claire A Martin  10   11 , Marc Lemoine  12 , Alejandro Carta Bergaz  13 , Frank Bogun  1 , Nick Linton  14 , Nicolas Derval  1 , Filip Schlosser  15 , Thomas Pambrun  1 , Jan Petru  16 , Meleze Hocini  1 , Luigi Pannone  2 , Martin Mudroch  16 , Josef Kautzner  15 , Pierre Jais  1 , Tobias Reichlin  17 , Petr Neužil  16 , Petr Peichl  15
Affiliations
Multicenter Study

Safety and efficacy of a lattice-tip catheter for ventricular arrhythmia ablation: the AFFERA Ventricular Arrhythmia Ablation Registry (AVAAR)

Frédéric Sacher et al. Europace. .

Abstract

Aims: The feasibility and safety of the lattice-tip catheter for ventricular arrhythmia (VA) ablation in humans remain largely unknown. This study aimed to assess feasibility, safety profile as well as patient outcomes after VA ablation with a lattice-tip catheter in a multicentre European registry.

Methods and results: All 18 European centres using the AFFERA system in September 2024 agreed to participate. Clinical, procedural, and follow-up data (minimum 3 months) were systematically collected and analysed. A total of 126 patients (18% female; mean age 59 ± 16 years) underwent VA ablation using the lattice-tip catheter during the inclusion period. Ablation indications included ventricular tachycardia (VT) in 99, premature ventricular complexes (PVCs) in 23, and ventricular fibrillation (VF) in 4 patients. Major and minor acute complications were observed in 7 (6%) and 18 (14%) procedures, respectively. They included thrombo-embolic event (n = 2), major bleeding (n = 2), ventricular fibrillation induction (n = 1), tamponade due to epicardial access (n = 1), and cardiogenic shock due to prolonged VT mapping (n = 1). Within the first month post-procedure, three patients died [from multi-organ failure (n = 2) and sepsis (n = 1)], two had worsening heart failure, one myocardial infarction, one sepsis, and one major gastro-intestinal bleeding. After a mean follow-up of 5.6 ± 3.7 months, absence of recurrence was 78% for PVC, 70% for VT, and 100% for VF.

Conclusion: In this complex population with refractory VA, ablation using the lattice-tip catheter appears feasible and relatively safe. In the absence of large, randomized trials, exhaustive registry is of key importance to ensure safety and efficacy of new catheter technologies.

Keywords: Lattice-tip catheter; Pulsed field ablation; Safety; VT ablation.

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Conflict of interest statement

Conflict of interest: Fr.S. reports modest consulting fees and speaking honorarium from Abbott, Biosense Webster, Boston Scientific, InHeart, and Medtronic as well as travel grant from Boston Scientific. H.P. reports consultancy/honoraria from Abbott, J+J Medtech, Boston Scientific, Biotronik, and Medtronic. V.C.U. has received honoraria from Medtronic for his professional training activities with the AFFERA system. M.L. reports travel grant from Biosense Webster, a research grant from Farapulse and was supported by the Research Promotion Fund of the Faculty of Medicine (Hamburg, ‘Clinician Scientist Program’). P.P. reports speaker’s honoraria from Abbott, Biosense Webster, Medtronic, and Boston Scientific. J.K. reports personal fees from Abbott, Biosense Webster, Biotronik, Boston Scientific, GE Healthcare, and Medtronic for participation in advisory boards, training activities, and lectures. P.N. reports consultant/research grant fees from Medtronic, Abbott, Boston Scientific, Johnson+Jonhnson (former Biosense Webster), Field Medical, and Circa. An.S. reports consulting fees and speaker’s honoraria from Biosense Webster, Medtronic, Abbott, and Boston Scientific. C.A.M. reports consultancy/honoraria from Medtronic, Boston Scientific, and Biosense Webster. T.R.: research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the sitem insel support funds, Biotronik, Boston Scientific, and Medtronic, all for work outside the submitted study; speaker/consulting honoraria or travel support from Abbott/SJM, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Farapulse, Medtronic, and Pfizer-BMS, all for work outside the submitted study; support for his institution’s fellowship programme from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic for work outside the submitted study. J.P.: speaker’s honoraria from Medtronic, Boston Sc., and Biosense Webster. J.L.: Medtronic—advisory/fellowship funding. All remaining authors have declared no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Summarizing the main findings of AVAAR.
Figure 1
Figure 1
Electro-anatomical voltage map performed with the lattice-tip catheter with a picture highlighting the specific design of this catheter.
Figure 2
Figure 2
Flowchart of our population depending on de novo vs. redo procedure. VA, ventricular arrhythmia; VT, ventricular tachycardia; PVC, premature ventricular contraction; VF, ventricular fibrillation; ICM, ischaemic cardiomyopathy; NICM, non-ischaemic cardiomyopathy; SHD, structural heart disease.
Figure 3
Figure 3
Tracings of a 71-year-old with induction of VF and AF during RF application due to current leakage due to damage of the shaft as shown by the white arrow. The catheter below is a standard one, without shaft damage.
Figure 4
Figure 4
Different profile of PFA applications with the lattice-tip catheter. Panel A shows a slight temperature increased (orange tracings) typical of effective application whereas panel B is typical of suboptimal application in the absence of temperature change (orange tracings).
See this image and copyright information in PMC

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