An approach to electroanatomical mapping with a pentaspline pulsed field catheter to guide atrial fibrillation ablation.

Background: Pulsed field ablation (PFA) of atrial fibrillation (AF) using a pentaspline multi-electrode catheter is commonly performed under fluoroscopic guidance. No data exist on the integration of this catheter within a three-dimensional electroanatomical mapping (3D-EAM) system for left atrial voltage and activation mapping, posterior wall isolation (PWI), or redo ablation. This technical report reviews an approach whereby mapping is performed using the pentaspline PFA catheter itself within an open architectural impedance-based 3D-EAM system.

Methods: Cases involved mapping with the PFA catheter itself, with real-time visualisation of the guidewire tip and catheter within the 3D-EAM system. In certain cases, additional 3D-EAM was performed with a grid-style high-density mapping catheter for comparison.

Results: In a series of 22 patients (45% female, mean age 63 ± 13 years, 55% paroxysmal AF, 27% redo procedures), mapping increased procedural times (mean 108 min vs. 68 min in fluoroscopy-only controls), without reducing fluoroscopy times. Three potential advantages of mapping with the PFA catheter were identified: (1) The technique helped identify sleeves of incomplete pulmonary vein isolation after index applications. (2) In the four cases mapped with both the PFA and grid-style catheters, voltage maps appeared concordant. (3) The technique helped facilitate robust PWI and identify inadvertent partial PWI.

Conclusions: 3D-EAM with a pentaspline PFA catheter itself is feasible, without the need for high-density mapping catheters. This approach has potential advantages over fluoroscopic-only guidance, although its long-term efficacy and cost-effectiveness require formal assessment.