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. 2025 Oct 3.
doi: 10.1007/s10840-025-02129-1. Online ahead of print.

Conventional pulsed-field ablation versus pulsed-field ablation with non-integrated three-dimensional mapping for paroxysmal and persistent atrial fibrillation ablation

Roberto Rordorf  1   2 , Stefano Bianchi  3 , Antonio Dello Russo  4   5 , Francesco Solimene  5   6 , Claudio Tondo  7   8 , Maurizio Malacrida  9 , Andrea Petretta  10 , Antonio Rossillo  11 , Sakis Themistoclakis  12 , Maurizio Russo  13 , Stefano Bandino  14 , Matteo Bertini  15 , Mario Volpicelli  16 , Gianluca Zingarini  17 , Gianfranco Tola  18 , Ilaria Meynet  19 , Gianfranco Mitacchione  20   21 , Antonio De Simone  22 , Beatrice Stegagno  9 , Michele Magnocavallo  3 , Michela Casella  5   10   23 , Vincenzo Schillaci  6 , Fabrizio Tundo  7 , Antonio Sanzo  24 , Giulio Zucchelli  25 , Saverio Iacopino  10
Affiliations

Conventional pulsed-field ablation versus pulsed-field ablation with non-integrated three-dimensional mapping for paroxysmal and persistent atrial fibrillation ablation

Roberto Rordorf et al. J Interv Card Electrophysiol. .

Abstract

Background: There is limited evidence on efficiency, effectiveness, and safety outcomes in the context of pulsed-field ablation (PFA) of atrial fibrillation (AF) when a 3D mapping system is used.

Purpose: To assess the impact of non-integrated 3D mapping systems in PFA for the treatment of AF.

Methods: Consecutive patients undergoing PFA (FARAPULSE system) at 17 centers were included. Procedures were stratified according to the use of 3D mapping system (MAP vs standard; STD).

Results: A total of 1804 patients were included, 484 (26.8%) with a 3D mapping system. MAP procedures had longer skin-to-skin (90 [75-120] min vs. 60 [50-70] min, p < 0.0001), cath lab utilization (120 [100-165] min vs. 70 [60-94] min, p < 0.0001), and fluoroscopy time (22 [17-28] min vs. 15 [11-21] min, p < 0.0001). The use of 3D mapping was not associated with a better long-term clinical outcome in the overall population (freedom from AF/atrial tachycardia (AT) of 82.5% in MAP procedures vs. 77.4% in STD procedures, HR = 0.737, 95% CI 0.53-1.03, p = 0.0746) as well as in PVI-only paroxysmal AF (86.5% vs. 80.3%, 0.67, 0.38-1.19, p = 0.172), in PVI plus additional lesion sets paroxysmal AF (72.7% vs. 77.8%, 1.08, 0.44-2.65, p = 0.869), or in PVI only persistent AF (76.0% vs. 68.0%, 0.86, 0.36-2.04, p = 0.727). A significantly higher arrhythmia recurrence-free rate was noticed in patients with persistent AF undergoing additional lesion set ablation (83.7% vs 70.3%, 0.45, 0.24 to 0.86, p = 0.016). Three major complications (0.2%) occurred, all in the STD group.

Conclusion: The use of a non-integrated 3D mapping system for PFA of AF did not significantly affect long-term success rates in paroxysmal AF or in patients undergoing PVI-only procedures.

Keywords: 3D mapping system; Atrial Fibrillation; Electroporation; Pulsed-field ablation.

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Conflict of interest statement

Declarations. Ethical approval: All authors made significant contributions to the data collection for this study and have reviewed and approved the manuscript in its present form. Disclosures: M. Malacrida and B. Stegagno are employees of Boston Scientific. The other authors have no conflicts of interest to declare that are relevant to the content of this article. Clinical trial registration: Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/ Identifier: NCT05617456.

References

    1. Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, et al. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol. 2024;67(5):921–1072. - DOI - PubMed
    1. Conte G, Soejima K, de Asmundis C, Bruno J, Cattaneo F, Chierchia GB, et al. High-density mapping in patients undergoing ablation of atrial fibrillation with the fourth-generation cryoballoon and the new spiral mapping catheter. Europace. 2020;22(11):1653–8. - DOI - PubMed
    1. Guhl EN, Adelstein E, Voigt A, Wang NC, Saba S, Jain SK. Impact of 3D mapping on procedural characteristics and outcomes in cryoballoon pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol. 2018;51(1):71–5. - DOI - PubMed
    1. Natale A, Mohanty S, Sanders P, Anter E, Shah A, Al Mohani G, et al. Catheter ablation for atrial fibrillation: indications and future perspective. Eur Heart J. 2024;45(41):4383–98. - DOI - PubMed
    1. Ekanem E, Neuzil P, Reichlin T, Kautzner J, van der Voort P, Jais P, et al. Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17k study. Nat Med. 2024;30(7):2020–9. - DOI - PubMed - PMC