| Title: |
How to: Streamlining Pulsed Field Ablation-Based Pulmonary Vein Isolation Using 3D Mapping Without Fluoroscopy |
| Authors: |
Yannick Teumer; Lyuboslav Katov; Carlo Bothner; Wolfgang Rottbauer; Karolina Weinmann-Emhardt |
| Source: |
Journal of Clinical Medicine ; Volume 14 ; Issue 12 ; Pages: 4290 |
| Publisher Information: |
Multidisciplinary Digital Publishing Institute |
| Publication Year: |
2025 |
| Collection: |
MDPI Open Access Publishing |
| Subject Terms: |
pulsed field ablation; zero fluoroscopy; optimized workflow; 3D mapping; electrophysiology; atrial fibrillation; transesophageal echocardiography |
| Description: |
Background: Pulsed field ablation (PFA) is a safe and effective method for pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients. However, most first-generation PFA catheters are not integrated with 3D mapping systems, requiring fluoroscopy for guidance. The use of X-ray technologies, however, poses significant health risks to both patients and operating staff. Recently, a new variable-loop PFA catheter (VLC) with full 3D mapping integration allows for a novel fluoroscopy-free approach to PVI. In that regard, the aim was to evaluate and optimize a zero-fluoroscopy workflow for PVI using the VLC. Methods: Two workflows were described and compared: a conventional zero-fluoroscopy approach using a complete 3D left atrial map before ablation, and an optimized ‘mapping-on-the-fly’ approach that combines mapping and ablation into a continuous, real-time process for each pulmonary vein rather than performing them sequentially. Results: Forty-one pulmonary veins were successfully treated without fluoroscopy in 10 patients (20% female, median age 61 [IQR 55.5–66.8] years). Three patients underwent the conventional workflow, while seven received the optimized workflow. The ‘mapping-on-the-fly’ approach significantly reduced procedural time (median 68 vs. 144 min, p = 0.017) and left atrial dwell time (46 vs. 107 min, p = 0.016). No fluoroscopy-related complications occurred. Conclusions: PVI using the fully 3D-integrated VLC can be safely and efficiently performed without fluoroscopy. The optimized ‘mapping-on-the-fly’ workflow improves procedural efficiency. |
| Document Type: |
text |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
Cardiovascular Medicine; https://dx.doi.org/10.3390/jcm14124290 |
| DOI: |
10.3390/jcm14124290 |
| Availability: |
https://doi.org/10.3390/jcm14124290 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.7FDFAD0E |
| Database: |
BASE |