A Novel Focal Lattice Tip Catheter Toggling Between Pulsed Field Energy and Radiofrequency for Atrial Arrhythmia Ablation: Results from a Real-World, Multicenter Registry

Introduction: A novel focal lattice tip catheter allowing the delivery of either pulsed field (PF) or radiofrequency (RF) energy has recently received regulatory approval. The technology features a proprietary 3D electroanatomical mapping system.

Objective: to describe the first real-world and multicentre experience.

Methods: Consecutive AF patients undergoing first-time or redo atrial tachyarrhythmia ablation with the Affera^TM system were prospectively enrolled at three different centres. PF was the only energy source allowed when ablating the posterior left atrium; anterior applications were performed using either RF (PF/RF strategy) or PF (PF/PF strategy) based on operator's preference. The primary efficacy endpoint included acute electrical isolation of pulmonary veins and posterior wall, or bidirectional block in case of linear lesions.

Results: 130 patients [mean age: 67±10 years; 63.8%(n=83) males; 61.5%(n=80) non-paroxysmal AF; 55.4% first-time AF ablation] were included. First-time PVI was performed in 72 pts: RF/PF in 13(18.1%) patients and PF/PF in the remaining 59(81.9%); first-pass isolation for PV and PW isolation were achieved in 100% of cases. A total of 289 ablation lines were performed [roof line:91pts; inferior line:83pts; anterior mitral line (AML):32pts; posterior mitral lines (PML):45pts; cavotricuspid isthmus (CTI) line:38pts]. First-pass isolation and primary efficacy endpoint were 96.2% (roof line:100%; inferior line:100%; AML:96.9%; PML:84.4%; CTI:92.1%) and 100%, respectively. We had two (1.5%) major complications: one ST-segment elevation at the infero-lateral leads requiring intracoronary nitrate administration and one complete atrioventricular block.

Conclusions: Catheter ablation via a novel 9-mm lattice tip catheter confirmed high efficacy and safety in a real-world scenario.