Reconnection Rate Research Articles

Why Doesn't the Observed Field‐Aligned Current Saturate With Increasing Interplanetary Electric Field?

AbstractTheoretical studies indicate that electric potential saturation in a polar cap ionosphere is regulated by the limited reconnection rate at the magnetopause associated with field‐aligned currents (FACs), predicting the possible saturation of FACs under large interplanetary electric field (IEF). However, recent statistical studies have shown that observed FACs increase linearly with IEF. To reconcile this disparity, numerical experiments are conducted to explore the response of FACs under large IEF. Results show that FACs may exhibit either linear or saturated responses, depending on the Alfvén Mach number. The magnetospheric closure paths of region 1 currents differ significantly between the linear and saturated conditions. In the linear case, essential parts of the region 1 current extend toward dayside and connect to the magnetopause currents, whereas these parts of currents almost disappear in the saturation state. Saturation usually occurs under sub‐Alfvénic solar wind conditions, so the observed FACs generally grow linearly with IEF.

Ablation outcome in patients with atrial fibrillation undergoing ICE-guided pulsed-field ablation

Abstract Background Prior experiences from preclinical studies indicate the critical need of catheter-tissue- contact for creation of consistent transmural lesions in pulsed-field ablation (PFA). Intracardiac echocardiography (ICE) not only provide real-time visualization of cardiac structures, but also ensure adequate contact with the tissue. Objective We evaluated ablation outcome and reconnection rate following ICE-guided PFA procedure in patients with atrial fibrillation (AF). Methods Consecutive patients receiving ICE-guided PFA procedure were included in this multi-center analysis. All patients received isolation of PVs (PVI). Additional ablation of left atrial posterior wall (LAPW) was decided based on operator’s discretion. Concentric overlapping lesions were placed in the LAPW. Number of applications were determined on a case-by-case basis. ICE and fluoroscopy were used to optimize contact between the PFA catheter and the targeted tissue. All procedures were performed under uninterrupted anticoagulation. Mapping was done before and after ablation to confirm electrical isolation. Arrhythmia-monitoring was done for 1-year with periodic clinic visits, event recorders and 7-day Holter monitoring. Results A total of 372 patients [age: 62.69 ± 10.41 years, male: 201 (71.3%), paroxysmal AF: 67 (18%)] were included in this analysis of which 48 (12.9%) underwent PVI-only and the remaining subjects received additional ablation of LAPW. Mean number of applications were 34.67 ± 8.88 and 73.65 ± 37.21 for PVI-only and PVI+LAPWI cohorts respectively (p<0.001). No major procedural complications such as esophageal injury, atrio-esophageal fistula, pericardial effusion requiring drainage or cerebrovascular accidents were reported. During 1-year follow-up, 38 (10.2%) patients underwent repeat procedure for recurrence. Reconnection of PV and LAPW were found in only 2 (5.2%) patients. In all 38 patients, new triggers initiating AF were detected to be originating from interatrial septum: 25 (65.8%), superior vena cava: 9 (23.7%), coronary sinus: 7 (18.4%) and left atrial appendage: 6 (15.8%). Conclusion ICE-guided PFA procedures are safe and produce durable lesions leading to very low reconnection rate. The recurrence was mostly due to new triggers initiating AF.

Heating in the solar atmosphere at a fin current sheet driven by magnetic flux cancellation

ABSTRACT Magnetic reconnection before flux cancellation in the solar photosphere when two opposite-polarity photospheric magnetic fragments are approaching one another is usually modelled by assuming that a small so-called ‘floating current sheet’ forms about a null point or separator that is situated in the overlying atmosphere. Here, instead we consider the reconnection that is initiated as soon as the fragments become close enough that their magnetic fields interact. The resulting current sheet, which we term a ‘fin sheet’ extends up from the null point or separator that is initially located in the solar surface. We develop here non-linear analyses for finite-length models of both fin and floating current sheets that extend the previous models that were limited to short floating current sheets. These enable the length of the current sheet and the rate of heating to be calculated in both cases as functions of the separation distance of the sources and the reconnection rate. Usually, the fin current sheet liberates more energy than a floating current sheet.

Impact of the Out‐Of‐Plane Flow Shear on Magnetic Reconnection at the Flanks of Earth's Magnetopause

AbstractMagnetic reconnection changes the magnetic field topology and facilitates the energy and particle exchange at magnetospheric boundaries such as the Earth's magnetopause. The flow shear perpendicular to the reconnecting plane prevails at the flank magnetopause under southward interplanetary magnetic field conditions. However, the effect of the out‐of‐plane flow shear on asymmetric reconnection is an open question. In this study, we utilize kinetic simulations to investigate the impact of the out‐of‐plane flow shear on asymmetric reconnection. By systematically varying the flow shear strength, we analyze the flow shear effects on the reconnection rate, the diffusion region structure, and the energy conversion rate. We find that the reconnection rate increases with the upstream out‐of‐plane flow shear, and for the same upstream conditions, it is higher at the dusk side than at the dawn side. The diffusion region is squeezed in the outflow direction due to magnetic pressure which is proportional to the square of the Alfvén Mach number of the shear flow. The out‐of‐plane flow shear increases the energy conversion rate , and for the same upstream conditions, the magnitude of is larger at the dusk side than at the dawn side. This study reveals that out‐of‐plane flow shear not only enhances the reconnection rate but also significantly boosts energy conversion, with more pronounced effects on the dusk‐side flank than on the dawn‐side flank. These insights pave the way for better understanding the solar wind‐magnetosphere interactions.

Effect of toroidal mode coupling on explosive dynamics of m/n = 3/1 double tearing mode

The CLT code was used to quantitatively study the impact of toroidal mode coupling on the explosive dynamics of the m/n = 3/1 double tearing mode. The focus of this study was on explosive reconnection processes, in which the energy bursts and the main mode no longer dominates when the separation between two rational surfaces is relatively large in the medium range. The development of higher m and n modes is facilitated by a relatively large separation between two rational surfaces, a small q min (the minimum value of the safety factor), or low resistivity. The relationships between the higher m and n mode development, explosive reconnection rate, and position exchange of 3/1 islands are summarized for the first time. Separation plays a more important role than q min in enhancing the development of higher m and n modes. At a relatively large separation, the good development of higher m and n modes greatly reduces the reconnection rate and suppresses the development of the main mode, resulting in the main mode not being able to develop sufficiently large to generate the position changes of 3/1 islands.

Systematic 2.5D resistive MHD simulations with ambipolar diffusion and Hall effect for fast magnetic reconnection

In this work, we explore the possibility of the Hall effect and ambipolar diffusion as a mechanism for fast reconnection. The reconnected flux of our resistive and resistive+Hall simulations replicates the GEM results. Furthermore, we investigate, for the first time, the effect of ambipolar diffusion in the GEM. The reconnected flux of the resistive+ambipolar and resistive+Hall+ambipolar simulations showed increases of up to 75% and 143%, respectively, compared to the resistive and resistive+Hall simulations, showing that ambipolar diffusion contributes significantly to the reconnected flux. Our second scenario has a magnetic Harris field without perturbations but with an out-of-plane component, known as a guide field. We found that the reconnection rate increased faster with ambipolar diffusion, reaching values close to 0.1 for the resistive+Hall+ambipolar simulation followed by the resistive+Hall. These two simulations achieved the highest kinetic energy, implying more efficient energy conversion during reconnection.

Predictors of first-pass isolation in patients with recurrent atrial fibrillation: A retrospective cohort study

BackgroundPulmonary vein isolation (PVI) is superior to antiarrhythmics for the management of atrial fibrillation (AF), but repeat ablation is often required for durable rhythm control. Factors influencing first-pass isolation (FPI), and whether FPI predicts durable isolation are not well known. ObjectiveTo determine factors associated with FPI and rates of chronic reconnection among those with and without FPI at index PVI in patients undergoing repeat ablation. MethodsWe retrospectively identified 483 patients at our institution who underwent first-time PVI in 2021. Of these, 63 who had repeat ablation between 2021 and 2023 were included in the study. Logistic regression was used for statistical analysis for predictors of FPI during index PVI. ResultsThe mean age was 65 years, 67% of patients were male, 90% were white and 73% had persistent AF. At index PVI, FPI was achieved in 58% of LPVs, 48% of RPVs, and 25% of (posterior wall) PW isolations. Bilateral FPI was achieved in 35% of patients. At redo PVI the right superior PV (47%) was most frequently reconnected. Lack of PFI of the RPVs at index PVI was associated with a 14-fold risk of chronic reconnection. Elevated left atrial (LA) voltage predicted the absence of FPI of the RPVs, but not the LPVs. ConclusionIncreased LA voltage predicts lack of FPI in the right but not left PVs. Lack of FPI of RPVs predicts chronic reconnection.

Three Types of Solar Coronal Rain during Magnetic Reconnection between Open and Closed Magnetic Structures

Coronal rain (CR) is a crucial part of the mass cycle between the corona and chromosphere. It includes flare-driven CR and two types of quiescent CR, along nonflaring active region closed loops and along open structures, separately, labeled as type I, type II, and type III CR, respectively. Among them, type I and type III CR are generally associated with magnetic reconnection. In this study, employing data taken by the Solar Dynamics Observatory and the Solar Upper Transition Region Imager on 2022 October 11, we report three types of CR during an interchange reconnection between open and closed magnetic field structures above the southeastern solar limb. The open and closed structures converge, with the formation of the current sheet at the interface, and reconnect. The newly formed closed and open structures then recede from the reconnection region. During the reconnection, coronal condensation occurs along the reconnecting closed loops and falls toward the solar surface along both loop legs, as type II CR. Subsequently, condensation happens in the newly formed closed loops and moves down toward the solar surface along both loop legs, as type I CR. Magnetic dips of the reconnecting open structures form during the reconnection. In the dips, condensation occurs and propagates along the open structures toward the solar surface as type III CR. Our results suggest that the reconnection rate may be crucial for the formation of type I and type III CR during reconnection.

Global Environmental Constraints on Magnetic Reconnection at the Magnetopause From In Situ Measurements

AbstractProgress in locating the X‐line on the magnetopause beyond the atypical due south interplanetary magnetic field (IMF) condition is hampered by the fact that the global plasma and field spatial distributions constraining where reconnection could develop on the magnetopause are poorly known. This work presents global maps of the magnetic shear, current density and reconnection rate, on the global dayside magnetopause, reconstructed from two decades of measurements from Cluster, Double Star, THEMIS and MMS missions. These maps, generated for various IMF and dipole tilt angles, offer a unique comparison point for models and observations. The magnetic shear obtained from vacuum magnetostatic draping is shown to be inconsistent with observed shear maps for IMF cone angles in 12.5° ± 2.5° ≤ |θco| ≤ 45° ± 5°. Modeled maximum magnetic shear lines fail to incline toward the equator as the IMF clock angle increases, in contrast to those from observations and MHD models. Reconnection rate and current density maps are closer together than they are from the shear maps, but this similarity vanishes for increasingly radial IMF orientations. The X‐lines maximizing the magnetic shear are the only ones to sharply turns toward and follow the anti‐parallel ridge at high latitude. We show the behavior of X‐lines with varying IMF clock and dipole tilt angles to be different as the IMF cone angle varies. Finally, we discuss a fundamental disagreement between X‐lines maximizing a given quantity on the magnetopause and predictions of local X‐line orientations.

Unraveling the Trigger Mechanism of Explosive Reconnection in Partially Ionized Solar Plasma

Plasmoid instability usually accounts for the onset of fast reconnection events observed in astrophysical plasmas. However, the measured reconnection rate from observations can be one order of magnitude higher than that derived from magnetohydrodynamic (MHD) simulations. In this study, we present the results of magnetic reconnection in the partially ionized low solar atmosphere based on 2.5D MHD simulations. The whole reconnection process covers two different fast reconnection phases. In the first phase, the slow Sweet–Parker reconnection transits to the plasmoid-mediated reconnection, and the reconnection rate reaches about 0.02. In the second phase, a faster explosive reconnection appears, with the reconnection rate reaching above 0.06. At the same time, a sharp decrease in plasma temperature and density at the principle X-point is observed, which is associated with the strong radiative cooling, the ejection of hot plasma from the local reconnection region, or the motion of the principle X-point from a hot and dense region to a cool and less dense region along the narrow current sheet. This causes gas pressure depletion and increases magnetic diffusion at the main X-point, resulting in the local Petschek-like reconnection and a violent and rapid increase in the reconnection rate. This study for the first time reveals a common phenomenon where the plasmoid-dominated reconnection transits to an explosive faster reconnection with a rate approaching the order of 0.1 in partially ionized plasma in the MHD scale.

Cold ion effects in density-asymmetric collisionless magnetic reconnection

The coexistence of low-energy (cold) ions and thermal (warm) ions is commonly observed in space and laboratory plasmas, such as those in magnetopause and fusion fueling processes. In certain events, the cold ion proportion may play a crucial role in plasma processes, especially magnetic reconnection. In this paper, magnetic reconnection with density-asymmetric cold ions is investigated in implicit particle-in-cell (iPIC) simulations. It is found that in such events the reconnection rate decreases as the cold ion distribution depth into the current sheet increases, mainly due to the mass-loading effect. Particularly, a density-peak structure of cold ions is developed in the reconnection region owing to the bounce motion of cold ions entering from the opposite inflow region. In the y–vy phase space where the y-direction is normal to the current sheet, a cold ion ring structure related to the bounce motion is formed and amplified by the Hall electric field. Furthermore, the cold ions become a notable current carrier due to its shorter inertial scale than the warm ions. Consequently, the asymmetry of the cold ion distribution significantly breaks the symmetry in the Hall magnetic field, eventually leading to asymmetric cold ion density peak structure. Such structures can be taken as significant signals of cold ion existence in in situ spacecraft observations.

Efficacy and safety of a novel temperature-controlled catheter for cavotricuspid isthmus ablation.

Maintaining an adequate temperature at the target site is essential for effective ablation. We hypothesized that a tissue temperature-controlled (T-Con) catheter for cavotricuspid isthmus (CTI) ablation could improve the procedural ablation parameters. To evaluate the efficacy and safety of the T-Con (DiamondTemp™) catheter for CTI ablation compared with non-irrigation (Non-Irri) and irrigation (Irri) catheters. We analyzed 150 patients who underwent prophylactic CTI ablation combined with pulmonary vein isolation. The Non-Irri, Irri, and T-Con catheter groups comprised 50 patients each, and the ablation procedural parameters and complications were compared between these groups. There were no significant differences in clinical background characteristics among the three groups. The Kruskal-Wallis and post hoc tests demonstrated that the T-Con group showed the lowest total radiofrequency energy delivery time among the three groups (median [25 and 75 percentiles]: 340 [209, 357], 147 [100, 199], and 83 [61, 109] s, respectively in the Non-Irri, Irri, and T-Con groups; T-Con versus Non-Irri, p < .01; T-Con versus Irri, p < .01). The total procedural time and acute reconnection rate in the T-Con group (264 s and 4%, respectively) were lower than those in the Non-Irri group (438 s and 24%) but were similar to those in the Irri group (268 s and 6%). No significant complications were observed in any group. The T-Con catheter achieved a short energy delivery time and a low acute reconnection rate, indicating its potential as an alternative catheter for CTI ablation.

Pulmonary vein isolation using pulsed field ablation vs. high-power short-duration radiofrequency ablation in paroxysmal atrial fibrillation: efficacy, safety, and long-term follow-up (PRIORI study).

Pulsed field ablation (PFA) is a novel, non-thermal, cardiac tissue-selective ablation modality. To date, radiofrequency (RF)-guided high-power short-duration (HPSD) ablation represents the gold standard besides cryo-ablation for pulmonary vein isolation (PVI). This single-centre, retrospective study investigated the efficacy of PFA-PVI vs. HPSD-RF PVI in terms of single-procedure arrhythmia-free outcome and safety in a real-world setting. Consecutive, paroxysmal atrial fibrillation (AF) patients who underwent PVI using PFA or HPSD-RF were enrolled. In group PFA, PVI was performed using a pentaspline PFA catheter. The ablation procedure in group HPSD-RF was performed with RF energy (45 W, ablation index). A total of 410 patients (group PFA, 201; group HPSD-RF, 209) were included. There was no difference between both groups regarding age, gender, and CHA2DS2-VASc score. The procedure time was significantly shorter in group PFA [61 (44-103) vs. 125 (105-143) min; P < 0.001]; fluoroscopy time and dose area product were significantly higher in group PFA [16 (13-20) vs. 4 (2-5) min; P < 0.01 and 412 (270-739) vs. 129 (58-265) μGym2; P < 0.01]. The overall complication rates were 2.9% in group PFA and 6.2% in group HPSD (P = 0.158). There was one fatal stroke in the PFA group. The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 85% with PFA and 79% with HPSD-RF (log-rank P = 0.160). In 56 repeat ablation procedures, the PV reconnection rate was 30% after PFA and 38% after HPSD-RF (P = 0.372). Both PFA and HPSD-RF were highly efficient and effective in achieving PVI in paroxysmal AF patients. The arrhythmia-free survival is comparable. The PV reconnection rate was not different.

Laboratory Study of Magnetic Reconnection in Lunar-relevant Mini-magnetospheres

Mini-magnetospheres are small ion-scale structures that are well suited to studying kinetic-scale physics of collisionless space plasmas. Such ion-scale magnetospheres can be found on local regions of the Moon, associated with the lunar crustal magnetic field. In this paper, we report on the laboratory experimental study of magnetic reconnection in laser-driven, lunar-like ion-scale magnetospheres on the Large Plasma Device at the University of California, Los Angeles. In the experiment, a high-repetition rate (1 Hz), nanosecond laser is used to drive a fast-moving, collisionless plasma that expands into the field generated by a pulsed magnetic dipole embedded into a background plasma and magnetic field. The high-repetition rate enables the acquisition of time-resolved volumetric data of the magnetic and electric fields to characterize magnetic reconnection and calculate the reconnection rate. We notably observe the formation of Hall fields associated with reconnection. Particle-in-cell simulations reproducing the experimental results were performed to study the microphysics of the interaction. By analyzing the generalized Ohm’s law terms, we find that the electron-only reconnection is driven by kinetic effects through the electron pressure anisotropy. These results are compared to recent satellite measurements that found evidence of magnetic reconnection near the lunar surface.

Three Dimensions of&lt;b&gt;&lt;/b&gt; Fan Reconnection

Many celestial occurrences, including solar flares and the solar corona and modifications to the magnetosphere of Earth, are thought to be caused by the reconnection process. This process occurs in highly conductive plasmas. One of the candidate places for this process is the three-dimensional zero points, in this process, stored energy is transformed into new types of energy Aims. Magnetic reconnection at a single null point: influence of magnetic field symmetry. Methods. We discussed a stable solution to several of the resistivity MHD formulations. Results. The field's asymmetry (k) may impact the propagation area dimensions and rate of reconnection in a variety of ways, depending on the parameters we choose.

Unified framework of forced magnetic reconnection and Alfvén resonance

A unified linear theory that includes forced reconnection as a particular case of Alfvén resonance is presented. We consider a generalized Taylor problem in which a sheared magnetic field is subject to a time-dependent boundary perturbation oscillating at frequency ω0. By analyzing the asymptotic time response of the system, the theory demonstrates that the Alfvén resonance is due to the residues at the resonant poles, in the complex frequency plane, introduced by the boundary perturbation. Alfvén resonance transitions towards forced reconnection, described by the constant-psi regime for (normalized) times t≫S1/3, when the forcing frequency of the boundary perturbation is ω0≪S−1/3, allowing the coupling of the Alfvén resonances across the neutral line with the reconnecting mode, as originally suggested in Uberoi and Zweibel, (1999). Additionally, it is shown that even if forced reconnection develops for finite, albeit small, frequencies, the reconnection rate and reconnected flux are strongly reduced for frequencies ω0≫S−3/5.

Efficacy and Safety of Laser Balloon Versus Irrigated Radiofrequency Ablation as Initial Therapies for Atrial Fibrillation: A Meta-Analysis.

Catheter ablation (CA) is an effective therapy for atrial fibrillation (AF) and, although radiofrequency ablation (RFA) is the standard treatment for pulmonary vein isolation (PVI), it is complex and time-consuming. Laser balloon ablation (LBA) has been introduced to simplify the conventional RFA; however, results of studies comparing LBA and RFA remain controversial. As such, this investigation aimed to comprehensively evaluate the efficacy and safety of LBA versus RFA. The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for relevant studies. The primary endpoints were the freedom from atrial tachyarrhythmia (ATA) and procedure-related complications. Twelve studies including 1274 subjects were included. LBA and RFA yielded similar rates of freedom from ATA (72.5% vs. 68.7%, odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.0-1.7, p = 0.11) and procedure-related complications (7.7% vs. 6.5%, OR = 1.17, 95% CI 0.72-1.90, p = 0.536). LBA with the second- and third-generation laser balloons (LB2/3) yielded remarkably higher rates of freedom from ATA than RFA using contact-force technology (RFA-CF) (OR = 1.91, p = 0.013). Significantly lower pulmonary vein (PV) reconnection rates (OR = 0.51, p = 0.021), but higher phrenic nerve palsy (PNP) rates (OR = 3.42, p = 0.023) were observed in the LBA group. LBA had comparable procedure (weighted mean difference [WMD] = 8.43 min, p = 0.337) and fluoroscopy times (WMD = 3.09 min, p = 0.174), but a longer ablation time (WMD = 12.57 min, p = 0.00) than those for RFA. LBA and RFA treatments were comparable in terms of freedom from ATA and postprocedural complications in patients with AF. Compared with RFA, LBA was associated with significantly lower PV reconnection rates, but a higher incidence of PNP and longer ablation time.

A Quantitative Analysis of the Uncertainties on Reconnection Electric Field Estimates Using Ionospheric Measurements

AbstractCalculating the magnetic flux transfer across the open‐closed boundary (OCB) per unit time and distance—the reconnection electric field—is an important means of remotely monitoring magnetospheric dynamics. Ground‐based measurements of plasma convection velocities together with velocities of the OCB are commonly used to infer reconnection rates. However, this approach is limited by spatial coverage and often lacks robust uncertainty quantification. In this paper, we assimilate Super Dual Auroral Radar Network convection measurements, ground magnetometer data, and estimates of the conductance derived from the Imager for Magnetopause‐to‐Aurora Global Exploration satellite imagers, using the Local mapping of polar ionospheric electrodynamics (Lompe) framework over a region in North America. We present a new method to assess various contributions to uncertainties in the derived reconnection electric fields, including a novel approach to estimate uncertainties in conductance from global auroral imaging. Our method is demonstrated on a substorm event with an associated pseudobreakup during a period of favorable observational coverage. In this case study, the uncertainties in the reconnection electric field are ∼5–10 mV/m at the peak of substorm expansion, roughly 15% of the peak reconnection electric field. We find that the main contributor to the reconnection electric field estimates after substorm onset is the OCB motion, whereas during the pseudobreakup the main contributor is ionospheric plasma convection.

Durability of pulmonary vein isolation after radiofrequency-balloon ablation

Abstract Aims Recently a multi-electrode radiofrequency balloon (RFB) for pulmonary vein isolation (PVI) was introduced. To the best of our knowledge no data on PVI durability has yet been published. Objectives The aim of this single-center study was to investigate the incidence of pulmonary vein (PV) reconnectionafter RFB-guided PVI. Methods Patients undergoing second ablation for recurrent atrial tachyarrhythmia (ATa) following the initial RFB-PVI were investigated. Left arial (LA) electroanatomic mapping was used. The rate of PV reconnection, the type of recurrent ATaand procedural data were analyzed. Results Among 178 patients treated with RFB, 21 patients underwent a second procedure 11 ± 6 months after the initial PVI. 67% of these patients presented with atrial fibrillation (AF), 33% with atrial tachycardia. Regarding baseline characteristics, 71% of these patients were male, mean age was 67±10, mean BMI was 28±5, 67% had hypertension and 33% had coronary artery disease. Overall, 83 PVs including one left common PV (LCPV) were assessed. The rate of PV reconnection was 28% (23/83 PVs). 57% of patients (12/21) had at least one reconnected PV. Patient with PV-reconnection had more AF recurrence and less often atrial tachycardia (AT) (AF: 75%, AT: 25%) than patients with durably isolated PVs (AF: 56%, AT: 44%). Most reconnections were detected in septal PVs. Reconnections were distributed as follows: RIPV: 8/21, RSPV: 7/21, LIPV: 5/20, LSVP: 3/20, LCPV: 0/1. Precise localization of the gaps could be identified in 15/23 PVs. Most common gap locations were at the anterior carina (4/15) for septal PVs and anterior-inferior (3/15) at the LIPV. Ablation strategy was pure PV reisolation in 8/12 patients and PV reisolation with additional linear lesions in 4/12 patients. All patients with durably isolated PVs were treated with additional substrate modification. In total, following additional lesions were set: anterior line: 6, roof line: 11, cavotricuspid isthmus (CTI): 7, LAA-Isolation: 1, free wall of the right atrium: 1. Regarding procedural data of the index procedure, the number of applications was not a statistically significant predictor of reconnection (p=0.77). Conclusion We provide the first insight into durability of PVI after radiofrequency-balloon ablation. 72% of all PVs were still isolated. Our data on gap localization might help to identify regions where optimal balloon contact is difficult to achieve. More data on this topic might reveal predictors for PV reconnections.

Procedural characteristics, details on epicardial mapping-based lesion transmurality, and long-term success of posterior wall isolation with a pentaspline pulsed field ablation device

Abstract Background Achieving durable posterior wall isolation (PWI) with thermal-based energies is challenging, as reconnection rates have been reported to be up to 60%. Additionally, PWI can significantly increase the risk of collateral thermal damage to the esophagus. Pulsed field ablation (PFA) is a non-thermal energy source with a remarkable safety profile due to its selectivity to cardiac tissue. Additionally, PWI durability was reported to be 100% in a recent phase-3 study enrolling persistent AF patients undergoing PFA via the FarapulseTM system. Purpose To report procedural details, acute lesion transmurality, and long-term success of PWI via the FarapulseTMsystem. Methods Consecutive persistent AF patients undergoing first-time ablation with the FarapulseTM system at four different centres were prospectively enrolled. All patients received first-time pulmonary vein isolation (PVI) and PWI. PFA was performed with either a 31mm or a 35mm device and an energy output of 2.0kV. At least 2 applications per position were delivered. Primary efficacy endpoint was freedom from any atrial tachyarrhythmia &amp;gt;30s after a 3month blanking period. PW lesion transmurality was assessed in a subpopulation of patients with an indication for hybrid AF ablation and left atrial appendage (LAA) clipping. The procedure was performed according to the following steps: 1) endocardial PVI plus PWI via the FarapulseTM system; 2) endocardial high-density mapping with RhythmiaTM plus Intellanav OrionTM; 3) thoracoscopy-assisted epicardial high-density mapping with Intellanav OrionTM 4) left atrial appendage clipping. Results 157 persistent AF patients (mean age: 62±11years; 75.5% males) were included. First-pass PVI was achieved in 100% of patients. On average, pulsed electric field applications for PWI were 16.3±2.4. Mean procedural time was 66±17min; left atrial dwelling and fluoroscopy times were 46±12min and 14±6min, respectively. SR restoration during PWI was observed in 8 (5.1%) cases. Minor and major periprocedural complications occurred in 2.5% (groin hematoma: 4pts) and 0.6% (diplopia with negative cerebral MRI) patients, respectively. During a mean follow-up of 353±58 days, arrhythmia-free survival was 78.3% (n=123). A redo ablation was performed in 23 patients, showing reconnection of 22.8% of PVs. Durable PWI was observed in 82.6% of patients. In the subpopulation of patients (n=3) undergoing hybrid ablation plus LAA clipping, thoracoscopy-guided epicardial mapping of the PW was performed between 57 and 72 minutes after the last endocardial PFA application. All patients showed transmural PWI (Figure1). Conclusions In a real-world multicenter registry, PWI by means of the FarapulseTM system was safe and feasible, contributing to approximately 80% success rate after 1 year. Endocardial PFA-based PWI led to 100% transmural lesions acutely, with a rate of reconnection &amp;lt;20% at redo procedures.