Abstract

Background Pulsed-field ablation (PFA) is becoming more widely used as its efficacy and safety. However, the durability of pulmonary vein isolation (PVI) is not necessarily satisfactory even with PFA. This study aimed to investigate whether post-PFA residual tiny pulmonary vein potentials (PVPs) on a high-resolution map may serve as a predictor of late-phase reconnection between the left atrium and pulmonary vein.

Methods Fifteen patients who underwent PFA-based PVI, and the second ablation for recurrent atrial tachyarrhythmias were enrolled. The association between residual tiny PVPs (≥ 0.03 mV) on a post-PFA high-resolution map and reconnected PVPs observed during the second ablation were studied. The presence or absence of PVPs in 270 pulmonary vein segments from 15 cases was compared between the post-PFA map of the initial ablation and the map from the second ablation.

Results Among 42 post-PFA residual tiny PVPs, 34 (81%) showed locational concordance with the late-phase reconnected PVPs identified at the second ablation. Thirty-four (52%) out of 66 late-phase reconnected PVPs at the second ablation were located at sites concordant with the post-PFA residual tiny PVPs. Post-PFA residual tiny PVPs defined as bipolar voltage of ≥ 0.03 mV well predicted late-phase reconnected PVPs (sensitivity=52%, specificity=96%, positive predictive value=81%, negative predictive value=86%).

Conclusion The presence of post-PFA residual tiny PVPs can be used as late-phase reconnection between the left atrium and pulmonary vein.

Condensed abstract This observational study aimed to investigate whether post-PFA residual tiny pulmonary vein potentials (PVPs) on a high-resolution map may serve as a predictor of late-phase reconnection between the left atrium and pulmonary vein. Fifteen patients were who underwent pulmonary vein isolation using pulse field ablation and the second ablation for recurrent atrial tachyarrhythmias were enrolled. Residual tiny PVPs defined as bipolar voltage of ≥ 0.03 mV well predicted late-phase reconnected PVPs (sensitivity=52%, specificity=96%, positive predictive value=81%, negative predictive value=86%). In conclusion, the presence of post-PFA residual tiny PVPs can be used as late-phase reconnection between the left atrium and pulmonary vein

Competing Interest Statement

Masuda M has received research fund from Johnson and Johnson outside the submitted work.

Funding Statement

No external funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Kansai Rosai Hospital IRB

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

Data will be available on request to the correspoding author.

Abbreviation listPVIpulmonary vein isolationAFatrial fibrillationPFApulse field ablationPVPspulmonary vein potentials