A novel focal lattice-tip catheter toggling between pulsed field energy and radiofrequency for atrial arrhythmia ablation: Results from a real-world, multicenter registry.

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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 3-dimensional electroanatomic mapping system. We describe the first real-world and multicenter experience. Consecutive AF patients undergoing first-time or redo atrial tachyarrhythmia ablation with the Affera system were prospectively enrolled at 3 different centers. PF was the only energy source allowed when ablating the posterior left atrium; anterior applications were performed with either RF (PF/RF strategy) or PF (PF/PF strategy) on the basis of the operator's preference. The primary efficacy end point included acute electrical isolation of pulmonary veins and posterior wall or bidirectional block in case of linear lesions. The study included 130 patients (mean age, 67 ± 10 years; 63.8% [n = 83] male; 61.5% [n = 80] nonparoxysmal AF; 55.4% first-time AF ablation). First-time pulmonary vein isolation was performed in 72 patients: RF/PF in 13 (18.1%) patients and PF/PF in the remaining 59 (81.9%); first-pass isolation for pulmonary vein and posterior wall was achieved in 100% of cases. A total of 289 ablation lines were performed (roof line, 91 patients; inferior line, 83 patients; anterior mitral line, 32 patients; posterior mitral line, 45 patients; cavotricuspid isthmus line, 38 patients). First-pass isolation and primary efficacy end point were 96.2% (roof line, 100%; inferior line, 100%; anterior mitral line, 96.9%; posterior mitral line, 84.4%; cavotricuspid isthmus, 92.1%) and 100%, respectively. We had 2 (1.5%) major complications: 1 ST-segment elevation at the inferolateral leads requiring intracoronary administration of nitrate and 1 complete atrioventricular block. Catheter ablation with a novel 9-mm lattice-tip catheter confirmed high efficacy and safety in a real-world scenario.