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Purpose <p>Unintended lesion formation on the left atrial (LA) posterior wall (LAPW) can occur during pulsed field ablation (PFA) for pulmonary vein (PV) isolation (PVI). We aimed to identify the factors associated with LAPW conduction block (LAPWB) during PVI using a pentaspline PFA catheter.</p> Methods <p>We retrospectively studied 99 consecutive patients undergoing an initial PVI of atrial fibrillation (AF) using the pentaspline catheter with basket and flower configurations at the PV ostium.</p> Results <p>Post-PVI mapping revealed LAPWB in 19 patients (19.2%). The ratio of the LAPW scar area was higher in the patients with LAPWB than those without (median, 70.5% vs. 41.0%, P &lt; 0.001). The patients with LAPWB had a smaller LA volume (computed tomography [CT], 97.1 ± 24.1 vs. 122.9 ± 34.6&#xa0;mL) and LAPW area (CT, 10.1 ± 2.7 vs. 14.3 ± 3.1 cm<sup>2</sup>; pre-PVI three-dimensional map [3D-map], 10.9 ± 2.7 vs. 14.5 ± 2.8 cm<sup>2</sup>) and shorter inter-superior and inter-inferior PV distances (CT, 26.5 ± 6.0 vs. 35.0 ± 5.6&#xa0;mm and 32.2 ± 6.5 vs. 37.8 ± 6.0&#xa0;mm; 3D-map, 26.9 ± 4.4 vs. 36.2 ± 6.0&#xa0;mm and 31.3 ± 6.6 vs. 38.9 ± 5.0&#xa0;mm) than those without (all P &lt; 0.01). The inter-superior PV distance on the 3D-map exhibited a larger area under the receiver operating characteristic curve of 0.902 than the others, and the sensitivity and specificity were 84.2% and 85.0%, respectively, at an optimal cutoff of 30.3&#xa0;mm.</p> Conclusions <p>AF patients with smaller LA and LAPW sizes, especially a shorter inter-superior PV distance on the 3D-map (&lt; 30.3&#xa0;mm in this study), may be at an increased risk of unintended LAPWB during PVI using the pentaspline catheter with basket and flower configurations.</p> Graphical Abstract <p></p>

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Unintended lesion formation and conduction block in the posterior left atrium during pulmonary vein isolation using a pentaspline pulsed field ablation catheter

  • 期刊论文

  • 发表日期：

    2025年11月21日

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  • Kohki Nakamura,
  • Takehito Sasaki,
  • Taiki Masuyama,
  • Kentaro Minami,
  • Shingo Yoshimura,
  • Suguru Nishiuchi,
  • Akiko Kodama,
  • Kojiro Hattori,
  • Kenichi Kaseno,
  • Nobusada Funabashi,
  • Shigeto Naito

摘要

Purpose

Unintended lesion formation on the left atrial (LA) posterior wall (LAPW) can occur during pulsed field ablation (PFA) for pulmonary vein (PV) isolation (PVI). We aimed to identify the factors associated with LAPW conduction block (LAPWB) during PVI using a pentaspline PFA catheter.

Methods

We retrospectively studied 99 consecutive patients undergoing an initial PVI of atrial fibrillation (AF) using the pentaspline catheter with basket and flower configurations at the PV ostium.

Results

Post-PVI mapping revealed LAPWB in 19 patients (19.2%). The ratio of the LAPW scar area was higher in the patients with LAPWB than those without (median, 70.5% vs. 41.0%, P < 0.001). The patients with LAPWB had a smaller LA volume (computed tomography [CT], 97.1 ± 24.1 vs. 122.9 ± 34.6 mL) and LAPW area (CT, 10.1 ± 2.7 vs. 14.3 ± 3.1 cm2; pre-PVI three-dimensional map [3D-map], 10.9 ± 2.7 vs. 14.5 ± 2.8 cm2) and shorter inter-superior and inter-inferior PV distances (CT, 26.5 ± 6.0 vs. 35.0 ± 5.6 mm and 32.2 ± 6.5 vs. 37.8 ± 6.0 mm; 3D-map, 26.9 ± 4.4 vs. 36.2 ± 6.0 mm and 31.3 ± 6.6 vs. 38.9 ± 5.0 mm) than those without (all P < 0.01). The inter-superior PV distance on the 3D-map exhibited a larger area under the receiver operating characteristic curve of 0.902 than the others, and the sensitivity and specificity were 84.2% and 85.0%, respectively, at an optimal cutoff of 30.3 mm.

Conclusions

AF patients with smaller LA and LAPW sizes, especially a shorter inter-superior PV distance on the 3D-map (< 30.3 mm in this study), may be at an increased risk of unintended LAPWB during PVI using the pentaspline catheter with basket and flower configurations.

Graphical Abstract