Abstract 4362995: Invasive Remapping to Assess Long-Term Durability of Pulmonary Vein Isolation for Pulsed Field Ablation with Zero Fluoroscopy Approach

Background: Pulsed field ablation (PFA) is a novel nonthermal ablation using irreversible electroporation to treat atrial fibrillation (AF). While PFA leads to rapid electrogram disappearance, long-term lesion durability across systems is less defined. This study evaluates lesion durability during the initial use of pentaspline catheter with the Opal HDX Mapping software and lesion tagging. Methods: Lesion durability was assessed ~6–10 weeks post-index ablation in AF patients using the Nav-enabled pentaspline catheter and Opal HDX (Boston Scientific). The system visualized catheter dynamics and generated automated field tags to guide lesion overlap. Results: 28 patients (64% paroxysmal AF, 54% male, mean age 74, CHA2DS2VASc 4.8±1) underwent zero-fluoroscopy AF ablation and remapping. General anesthesia and same-day discharge were standard. All PVs and SVC were isolated; Posterior wall (PW) isolation (PWI) was performed in 44%, Posterior mitral isthmus (PMI) in 12%, Cavotricuspid isthmus (CTI) in 18%. Mean procedure time was 42±8 minutes. Average PFA applications were PV 52±4, PW 12±4, PMI 7±2, CTI 7±2, and SVC 2±0. Remapping after ~50 days showed 96% PV durability; 98% patients had all veins isolated. PWI durability was 90%, PMI 62%, CTI 92%, and SVC 100%. Two patients had atrial flutter (PMI reconnection). One had transient ST elevation, one had a TIA. No renal failure was seen. In a propensity-matched cohort of 28 patients from the same center who underwent ablation with the Non-Nav enabled pentaspline catheter using other 3D mapping systems, the use of Opal software showed 22% fewer lesion delivery, with less hemolysis and renal failure. Conclusions: PFA with Opal HDX and the Nav enabled Farawave catheter achieved effective, zero-fluoroscopy AF ablation with durable lesions and fewer applications. Nearly all veins remained isolated, and complication rates were low. This workflow reduced lesion count and risks compared to standard systems. Further study is needed for improving PMI outcomes.