Ablation of cavotricuspid isthmus–dependent atrial flutter using a focal monopolar pulsed-field ablation catheter: Feasibility, periprocedural coronary spasms and conduction disorders
Florent I.P. Farnir, Sevasti‐Maria Chaldoupi, B J M Hermans, Arne Johannessen, Martin Haugdal, Martin H. Ruwald, Tasnim Mohaissen, Arnela Saljic, Kezia Jerltorp, Sarah Dalgas Nissen, Julie Norup Hertel, Frédéric Farnir, Thomas Jespersen, Ulrich Schotten, Justin Luermans, Kevin Vernooy, J. P. Hart Hansen, Dominik Linz
Abstract
BACKGROUND: Pulsed-field ablation for the treatment of cavotricuspid isthmus (CTI)-dependent atrial flutter has been associated with coronary spasms (CS) and atrioventricular conduction disorders (CD). OBJECTIVES: The purpose of this study was to evaluate the feasibility of CTI ablation using a monopolar focal pulsed-field ablation (F-PFA) catheter and to assess the risk of CS and CD during and after the procedure. METHODS: We prospectively enrolled patients with atrial flutter treated with an F-PFA system (CardioFocus, Marlborough, MA) or by focal radiofrequency ablation (RFA) using contact force-sensing catheters integrated into electroanatomic mapping systems. Intravenous nitroglycerin was administered prior to F-PFA. Feasibility and safety with a focus on CS or CD were assessed. In a subgroup of patients, the course of the right coronary artery and the His position were determined. RESULTS: -VA score 2 ± 1.3). For F-PFA, the rate of first-pass block was higher (93% vs 55%) and the median (interquartile range) procedure times were shorter (7 [5-11] minutes vs 17 [15-19] minutes) than for RFA. In the F-PFA group, 4 patients (5%) had transient ST-segment elevation and 2 patients (2%) had transient complete atrioventricular block during ablation. There was a small but significant prolongation of the PQ interval after CTI ablation in the F-PFA group. CONCLUSION: CTI ablation using F-PFA is feasible, but operators should be aware of rare but critical CD and CS during the procedure, even when preventive measures such as nitroglycerin administration are used.