Assessment of incomplete lesions using 3-dimensional mapping following pentaspline pulsed field ablation for atrial fibrillation.

Background: Pulsed field ablation (PFA) is a novel nonthermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, the completeness of lesion formation following PFA using a pentaspline catheter remains insufficiently studied. Objective: This study aimed to evaluate the utility of 3-dimensional (3D) electroanatomical mapping in detecting incomplete lesion formation following pentaspline PFA in patients with AF. Methods: This study included 100 consecutive patients undergoing first-time PFA with the FARAWAVE™ catheter (Boston Scientific) under fluoroscopic guidance. 50 patients with paroxysmal AF underwent PVI alone, whereas 50 with persistent AF received PVI plus posterior wall isolation (PWI). Post-ablation 3D mapping was performed using the CARTO 3 system (Biosense Webster). Incomplete lesions were defined as preserved electrical activity or conduction gaps on activation or electrogram mapping. Results: Incomplete lesions were identified in 8 of 50 patients (16%) undergoing PVI alone and 24 of 50 patients (48%) undergoing PVI plus PWI (P < .001). The most common sites of residual conduction were the right inferior pulmonary vein (PVI group) and the mid-to-inferior posterior wall (PVI plus PWI group). 5 of 24 patients (21%) with incomplete PWI required multiple application-remapping cycles to achieve lesion completion. Analysis by quartile (n = 25) revealed no significant trend in detection rate over time for paroxysmal (P = .289) or persistent AF (P = .179). Conclusion: 3D electroanatomical mapping effectively identifies incomplete lesions following pentaspline PFA. Detection rates were unaffected by operator learning curve, instead reflecting limitations of conventional guidance based primarily on fluoroscopy in patients with anatomical variability.