Utility of intracardiac echocardiography during pulsed-field ablation of atrial fibrillation: preliminary experience in large multicenter clinical setting

Abstract Funding Acknowledgements Type of funding sources: None. Background Intracardiac echocardiography (ICE) is becoming more common during the ablation atrial fibrillation (AF) and it may improve procedural effectiveness. However, there no evidence evaluating efficiency, effectiveness, safety outcomes ICE in context novel pulsed-field (PFA) AF. Purpose We aimed to evaluate impact on parameters consecutive patients (pts) indicated for AF with a new PFA technology. Methods All pts undergoing at 5 experienced centers were included. Protocol-directed PVI was delivered using 2000 V eight applications per vein, that is, four each basket flower poses. Additional lesions performed operator’s discretion. In procedures which an catheter used, utilized manipulate left atrium reach optimal contact structures. At end procedures, identification procedure-related complications. Data are reported as median [IQ range]. Results One-hundred eighty included this analysis (36[32-40] center; n=124, 69% paroxysmal AF; n=56, 31% persistent AF). The ICE-guided consisted 35 (19.4%) cases. achieved all 32[32-32.5] pt. outside PVs (i.e. posterior wall ablation) 31 (17%) cases, requiring 18[12.5-26] deliveries lesion sets, validated through 3D mapping and/or differential pacing. Fluoroscopy time 17[13-22]min, LA dwell 22.5[18.5-27.5]min, skin-to-skin 60[52-80]min total support (procedural plus patient preparation) 75[60-90]min. Considering only use did not metrics (ICE vs ICE: 23[20-26]min 23[19-27]min PVI, p=0.4141; 65[64-85]min 70[60-82]min time, p=0.8271; 60[58-60]min 60[50-75]min p=0.8681 19[16-23]min 15[12-18]min fluoroscopy p=0.0012). On contrary, when looking additional showed some improvements 27.5[25-30]min 16[13-20]min p=0.0003; 75[65-80]min 120[90-145]min p=0.0032; 70[60-74]min 82.5[74-112.5]min p=0.0077 20[16.5-22]min 20[17-30]min p=0.3328). No major adverse events reported. Conclusion our preliminary experience, system safe effective. integration guiding ablation, provide beneficial aspects, especially complex sets.