Pulsed electric field for pulmonary vein isolation in paroxysmal atrial fibrillation: A multicenter experience comparing pentaspline and lattice-tip catheters.

BACKGROUND: We conducted a multicenter study to compare procedural and 1-year outcomes of pulmonary vein isolation (PVI) using lattice-tip (LT) vs pentaspline (PS) pulsed field ablation catheters in patients with paroxysmal atrial fibrillation. OBJECTIVE: This study aimed to compare procedural metrics and arrhythmia-free survival during the 1-year follow-up. METHODS: Procedures were performed between August 2023 and December 2024. A propensity score matching technique was adopted (LT-to-PS ratio 1:2). RESULTS: Among 447 patients with paroxysmal atrial fibrillation undergoing first-time PVI with either an LT (n = 74) or a PS catheter (n = 391), propensity score matching yielded 50 (LT group) and 100 patients (PS group), respectively. No differences were reported for first-pass isolation per patient (96% [LT group] vs 97% [PS group]; P = .75) and per pulmonary vein (98.9% [LT group] vs 99.2% [PS group]; P = .75). The LT group showed longer procedural (56 vs 50; P < .0001) and dwelling times (40 vs 30; P < .0001) but reduced fluoroscopy times (5 vs 10; P < .0001). No differences were reported for overall (2% vs 2%; P = 1.0) and major complications (0% vs 0%; P = 1.0). At 1-year follow-up, similar freedom from atrial tachyarrhythmia (86.2% [LT group] vs 83% [PS group]; P = .59) and atrial fibrillation (90.7% [LT group] vs 85.8% [PS group]; P = .41) was observed. CONCLUSION: First-time PVI using an LT or a PS pulsed field ablation catheter showed high efficacy and 1-year freedom from atrial tachyarrhythmias, without differences between groups. The LT catheter yielded longer procedural and dwelling times, but a significant reduction in fluoroscopy time.