Impact of Pulmonary Vein Morphology on the Number of Pulsed Field Ablation Applications Using Circular Multielectrode Catheters

ABSTRACT Introduction Pulmonary veins (PVs) morphology may affect the number of applications for acute antral PV isolation (PVI) with pulsed field ablation (PFA) using circular multielectrode catheters (PulseSelect, Medtronic) for atrial fibrillation (AF). We investigated the relationship between PV morphology and the number of PFA applications for antral PVI. Methods Forty‐five patients (180 PVs) with AF underwent initial PFA. PV morphology was assessed by preprocedural computed tomography. The minimal PFA protocol was defined as four ostial and four antral applications per PV. Antral PVI was confirmed after the minimal PFA protocol by multielectrode mapping catheters on 3‐dimensional electroanatomic mapping systems. PV morphology was compared between PVs with and without antral PVI by the minimal PFA protocol. Results Antral PVI by the minimal PFA protocol was obtained in 138 (77%) PVs. PVs without antral PVI by the minimal PFA protocol revealed larger long axis diameters (23.1 ± 5.4 vs. 20.1 ± 4.3 mm, p < 0.001), larger short axis diameters (19.0 ± 5.5 vs. 16.3 ± 4.0 mm, p = 0.005), and larger PV areas (PVAs) (362.7 ± 178.4 vs. 265.9 ± 115.2 mm 2 , p = 0.010). PVA was the only independent predictor among the clinical characteristics for antral PVI after the minimal PFA protocol (adjusted odds ratio per 10 mm 2 0.867; 95% confidence interval 0.817–0.920; p < 0.001). Conclusions Antral PVI was not accomplished in 23% of PVs by the minimal PFA protocol using circular multielectrode catheters. Additional PFA should be considered for larger PVs.