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. 2025 Aug 21;6(11):1706-1715.
doi: 10.1016/j.hroo.2025.08.030. eCollection 2025 Nov.

Real-world comparison of variable vs fixed-loop circular pulsed field ablation catheters: Acute outcomes including non-pulmonary vein ablation

Joerg Yogarajah  1 , Julie Hutter  1 , Patrick Kahle  1 , Marko Tomic  1 , Mirlinda Lüsebrink  1 , Andreas Hain  1 , Samuel Sossalla  1   2 , Malte Kuniss  1 , Thomas Neumann  1
Affiliations

Real-world comparison of variable vs fixed-loop circular pulsed field ablation catheters: Acute outcomes including non-pulmonary vein ablation

Joerg Yogarajah et al. Heart Rhythm O2. .

Abstract

Background: Pulsed field ablation (PFA) is an emerging non-thermal approach for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative real-world data between variable-loop circular catheter (VLCC; VARIPULSE™, Biosense Webster, Inc) and fixed-loop circular catheter (FLCC; PulseSelect™, Medtronic) catheters, including non-PVI ablation, are limited.

Objective: To compare acute efficacy, procedural characteristics, and safety of PVI, and adjunctive ablations performed with VLCC vs FLCC during clinical implementation.

Methods: Overall, 90 consecutive patients were studied (first 45 VLCC and 45 FLCC cases). FLCC procedures used fluoroscopic guidance; VLCC was integrated with 3-dimensional mapping, reflecting standard real-world use of each catheter. Additional ablations were performed at the operator's discretion. Acute outcomes and complications were analyzed.

Results: Acute PVI success was 100% in both groups. Additional ablations (cavotricuspid isthmus [CTI], roof lines, posterior wall, superior vena cava [SVC]) were performed in 17 (VLCC) and 15 (FLCC) patients, achieving bidirectional block without Radiofrequency touch-ups. In PVI-only cases, FLCC was associated with shorter median procedure time (67.2 vs 76 min, P < .001), whereas VLCC had reduced fluoroscopy time (8.3 vs 11.4 min, P < .001). Major complication rates were low and comparable (2.2% vs 0%, P = 1).

Conclusion: This first clinical comparison demonstrated high acute efficacy and favorable safety profiles, with notable procedural differences reflecting their distinct workflows of 2 circular PFA catheter systems for AF ablation. Likewise, this includes the first reported successful CTI, SVC and mitral isthmus ablation using VLCC reflecting its versatility for ablation. Further research is warranted to assess long-term outcomes and lesion durability.

Keywords: Atrial fibrillation; Atrial flutter; Catheter ablation; Cavotricuspid isthmus ablation; Left atrial roof ablation; Posterior wall isolation; Pulsed field ablation.

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Conflict of interest statement

JY, JH, PK, ML, MK, and TN received educational grants from Johnson & Johnson. MK reports advisory board activities for Medtronic and received fees from Medtronic. TN received fees from Johnson & Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1
Maneuvers for roof line (A-C) and CTI ablation (D-E) using FLCC. A: First application (RAO). B: The roof line was created by slight sheath retraction and controlled rotation of the PFA catheter (RAO). C: Last application (RAO). D: CTI ablation (RAO). E: CTI ablation (LAO). CTI = cavotricuspid isthmus ablation; FLCC = fixed-loop circular catheter; LAO = left anterior oblique; RAO = right anterior oblique.
Figure 2
Figure 2
Electroanatomic map with variable-loop circular catheter. Left atrium and pulmonary veins in atrial fibrillation before (A) and after (B and C) pulmonary vein isolation and posterior wall isolation in sinus rhythm. Superior vena cava before (D) and after (E) isolation, both in sinus rhythm.
Figure 3
Figure 3
Electroanatomic map with variable-loop circular catheter. A+ B: Right atrium after cavotricuspid isthmus ablation. C: Left atrium after posterior mitral isthmus line ablation.
Figure 4
Figure 4
Comparison of procedural parameters between 2 circular pulsed field ablation catheters. A: Procedural time. B: Left atrial dwell time. C: Fluoroscopy time. FLCC = fixed-loop circular catheter. VLCC = variable-loop circular catheter.
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