Posterior Pulmonary Vein Isolation Lesion Spacing and Left Atrial Posterior Wall Narrowing During Pulsed Field Ablation.
- 1Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan.
Abstract
Left atrial posterior wall (LAPW) narrowing after excessive extension of bilateral pulmonary vein isolation (PVI) lines during pulsed field ablation (PFA) may create a proarrhythmic substrate. The CARTO 3-integrated variable-loop circular catheter (VLCC) provides real-time tissue proximity indication (TPI) and ablation-tag location, but their relationship with LAPW narrowing remains unclear. Therefore, we evaluated associations of TPI status and inter-tag distance (ITD) with acute LAPW narrowing and whether an ITD-guided workflow was associated with LAPW preservation. Fifty-two retrospective and 27 prospective atrial fibrillation patients underwent PFA using a VLCC. In the retrospective phase, we evaluated the association between ITD, measured using TPI-positive tags and all tags, and LAPW narrowing (< 10 mm) and derived a cutoff. In the prospective phase, the ITD-guided workflow was applied, and we assessed residual LAPW band width. In the retrospective phase, both TPI-positive-tag ITD and all-tag ITD correlated with LAPW band width (r = 0.63 and 0.70, respectively; both p < 0.001). All-tag ITD showed a numerically higher AUC for LAPW narrowing than TPI-positive-tag ITD (0.869 vs. 0.795; p = 0.099), with an optimal all-tag ITD cutoff of 16.5 mm. In the prospective phase incorporating the all-tag ITD cutoff, residual LAPW band widths were wider at the roof (19.4 ± 7.9 vs. 25.1 ± 7.1 mm; p = 0.002) and carina (13.6 ± 7.1 vs. 20.8 ± 8.0 mm; p < 0.001) than in the retrospective phase. An all-tag ITD-guided workflow was associated with greater preservation of the residual LAPW band width.
Related
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BibTeX
@article{saito2026posterior,
title = {{Posterior Pulmonary Vein Isolation Lesion Spacing and Left Atrial Posterior Wall Narrowing During Pulsed Field Ablation.}},
author = {Yuji Saito and Koichi Nagashima and Ryuta Watanabe and Naoto Otsuka and Shu Hirata and Moyuru Hirata and Masanaru Sawada and Hikaru Masuda and Akinori Matsushima and Masato Sakaki and Yasuo Okumura},
journal = {Journal of arrhythmia},
year = {2026},
month = oct,
doi = {10.1002/joa3.70509},
url = {https://europepmc.org/article/MED/42953657},
note = {CC BY},
}
RIS
TY - JOUR
TI - Posterior Pulmonary Vein Isolation Lesion Spacing and Left Atrial Posterior Wall Narrowing During Pulsed Field Ablation.
AU - Yuji Saito
AU - Koichi Nagashima
AU - Ryuta Watanabe
AU - Naoto Otsuka
AU - Shu Hirata
AU - Moyuru Hirata
AU - Masanaru Sawada
AU - Hikaru Masuda
AU - Akinori Matsushima
AU - Masato Sakaki
AU - Yasuo Okumura
PY - 2026
DA - 2026/10/28
JO - Journal of arrhythmia
DO - 10.1002/joa3.70509
UR - https://europepmc.org/article/MED/42953657
AB - Left atrial posterior wall (LAPW) narrowing after excessive extension of bilateral pulmonary vein isolation (PVI) lines during pulsed field ablation (PFA) may create a proarrhythmic substrate. The CARTO 3-integrated variable-loop circular catheter (VLCC) provides real-time tissue proximity indication (TPI) and ablation-tag location, but their relationship with LAPW narrowing remains unclear. Therefore, we evaluated associations of TPI status and inter-tag distance (ITD) with acute LAPW narrowing and whether an ITD-guided workflow was associated with LAPW preservation. Fifty-two retrospective and 27 prospective atrial fibrillation patients underwent PFA using a VLCC. In the retrospective phase, we evaluated the association between ITD, measured using TPI-positive tags and all tags, and LAPW narrowing (< 10 mm) and derived a cutoff. In the prospective phase, the ITD-guided workflow was applied, and we assessed residual LAPW band width. In the retrospective phase, both TPI-positive-tag ITD and all-tag ITD correlated with LAPW band width (r = 0.63 and 0.70, respectively; both p < 0.001). All-tag ITD showed a numerically higher AUC for LAPW narrowing than TPI-positive-tag ITD (0.869 vs. 0.795; p = 0.099), with an optimal all-tag ITD cutoff of 16.5 mm. In the prospective phase incorporating the all-tag ITD cutoff, residual LAPW band widths were wider at the roof (19.4 ± 7.9 vs. 25.1 ± 7.1 mm; p = 0.002) and carina (13.6 ± 7.1 vs. 20.8 ± 8.0 mm; p < 0.001) than in the retrospective phase. An all-tag ITD-guided workflow was associated with greater preservation of the residual LAPW band width.
SN - 1880-4276
SN - 1883-2148
ER -