Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-125 - First-in-human Experience With Cavotricuspid Isthmus Ablation Using A Focal Pulsed Field Ablation Catheter (ID 1020)


Background: The cavotricuspid isthmus (CTI) is a common adjunct target for ablation during PVI procedures. Current technologies for CTI ablation require close spacing of discrete thermal lesions, are contact dependent, and rarely, can damage the right coronary artery. The CTI also can have a complex topography challenging for ablation. Pulsed field ablation (PFA) may offer benefits for CTI ablation due to its speed, reduced contact-dependence and myocardial specificity.
Objective: To evaluate the use of a novel, focal PFA catheter for achieving bi-directional block (BDB) across the CTI.
Methods: In 2 PVI studies, PEFCAT2 (NCT04170608) and PersAFone (NCT04170621), concomitant CTI ablation was performed. A 12 F deflectable 4-spline catheter (Faraflex, Farapulse Inc), which opens to 13mm diameter, was advanced through a 13F deflectable sheath, and PFA was delivered to the CTI. Fluoroscopy and ICE were used in all cases, and electroanatomical mapping was used in a subset of cases (n=3).
Results: At 2 centers, 13 pts (age 62±14 yrs, 7 male, 4 PAF / 9 PerAF) underwent CTI ablation: BDB was achieved in all 13 pts (100%) with the focal PFA catheter. Excluding the 1st procedure for device adaptation, PFA was delivered to the 5.7±2.2 sites/pt (total 6.7±2.2 grouped lesions/pt), with elapsed duration from first to last lesion of 7.2±3.7 min for BDB. BDB was confirmed after a 15-min wait (3 pts) and adenosine challenge (1 pt). There were no adverse device effects and no primary safety events at 35.2±16.2 days follow up.
Conclusion: A focal PFA catheter can successfully achieve BDB across the CTI. Advantages include ease-of-use, reduced contact dependency, speed of delivery, and myocardial tissue specificity.