Vishal Luther

Background: Pulsed‐field ablation (PFA) has transformed atrial fibrillation (AF) ablation, but how the early patient experience compares with thermal techniques remains unclear. This study aimed to assess patient‐reported outcome measures (PROMs) in the first 3 months after PFA or thermal AF ablation, using a novel smartphone‐based application. Methods: Patients undergoing first‐time pulmonary vein isolation prospectively completed the Cardiac Ablation Recovery Evaluation (CARE) symptom questionnaire at five timepoints: baseline, day 1, day 7, day 30, and day 90. Symptoms were rated on a 7‐point Likert scale (0 = not at all; 6 = extremely). Patients also completed the Atrial Fibrillation Effect on QualiTy‐of‐life (AFEQT) questionnaire at baseline and day 90. Results: Two hundred and two patients were included (pentaspline PFA: 66; radiofrequency: 64; cryoballoon: 72), with similar baseline demographics between groups, except for a lower prevalence of paroxysmal AF in the PFA group. Engagement with the smartphone‐based platform was high, with a 94.7% completion rate. Median AFEQT scores improved from 64 (47–82) at baseline to 86 (72–95) at day 90 ( p < 0.001), with no significant differences between modalities ( p = 0.841). However, CARE detected differences in early symptom experience: chest pain was lowest with PFA at day 1 (median: PFA, 1 [0–2]; radiofrequency, 2 [1–2]; cryoballoon, 2 [1–2]; p < 0.001), and remained lower than cryoballoon at day 7 ( p = 0.019), with differences resolving by day 30. Moderate‐to‐severe chest pain (score ≥ 3) occurred in only 12.3% of PFA patients at day 1, compared with 21.2% cryoballoon and 26.2% radiofrequency patients ( p < 0.001). Palpitations at day 1 were less frequent with PFA than radiofrequency ( p = 0.040). Groin discomfort was lower with radiofrequency than PFA or cryoballoon at day 1 ( p = 0.006) and day 7 ( p < 0.001), likely reflecting a smaller sheath size. Conclusions: PFA was associated with a modest and transient reduction in early post‐procedural chest pain compared with thermal ablation. Smartphone application‐based PROMs collection using the CARE questionnaire was feasible, enabling structured assessment of symptom burden across multiple recovery timepoints.

Background: Achieving adequate lesion depth during ventricular tachycardia (VT) ablation within scar is challenging with conventional radiofrequency energy (RF). The lattice-tip catheter enables dual-energy ablation (RF & pulsed field [PF]) with enhanced tissue penetration. Objective: We report on 3 cardiac implantable electronic device (CIED) patients with transmural apical left ventricular (LV) scars and drug-refractory VT. Each underwent endocardial LV ablation using RF & stacked PF. Ablation included delivery near the opposing surface of CIED leads, at sites critical for the VT circuit. CIED parameters were assessed pre- and post-procedure, as well as at interval follow-up. Results: VT was eliminated with complete non-inducibility achieved in all cases, and there has been no recurrence at early follow-up (4-6months). However, each case demonstrated inadvertent CIED lead capture threshold rise (apical right ventricular x2, anterolateral LV coronary sinus branch x1), with partial recovery over time. Findings correlated with ablation near opposing lead electrodes. Conclusion: Dual-energy lattice-tip ablation creates effective ventricular lesions through transmural scar that may increase CIED capture thresholds on the opposing myocardial surface. Our report recommends vigilance during ablation opposing CIED leads, balancing the respective wall thickness and potential for lead damage against the gravity of the arrhythmic presentation.

Background: Differences in baseline characteristics and clinical outcomes exist between female and male patients with atrial fibrillation (AF).Objective: To assess sex‐specific symptoms within 1 month of AF catheter ablation.Methods: Patients undergoing AF ablation between 2000 and 2024 were identified from 57 healthcare organizations using a global federated research network. Female and male patients were 1:1 propensity score matched (PSM) based on baseline characteristics. Symptoms within a month of ablation were identified using ICD‐10 codes and classified into major systems: cardiac (chest pain, palpitations), respiratory (dyspnea, cough), gastrointestinal (nausea, vomiting, heartburn, dysphagia, bloating, diarrhea, constipation, anorexia), neurological (headache, visual disturbance, speech disturbance, dizziness) and urological (urinary retention and dysuria).Results: After PSM, 69 244 patients were included (34 622 in each group). Female patients had a higher incidence of cardiac (female, 8.9% vs. male, 6.1%; p < 0.001), respiratory (7.9% vs. 6.1%; p < 0.001), gastrointestinal (3.4% vs. 2.2%; p < 0.001) and neurological symptoms (3.1% vs. 2.5%; p < 0.001) compared with male patients. Urological symptoms were more common in male patients (1.6% vs. 0.9%; p < 0.001) due to a higher incidence of urinary retention (1.1% vs. 0.3%; p < 0.001). All individual symptom components of cardiac, respiratory, gastrointestinal and neurological composites were more common in female patients, except from heartburn (0.1% vs. 0.1%; p = 0.49), bloating (0.2% vs. 0.2%; p > 0.99), anorexia (0.1% vs. 0.1%; p = 0.79), and speech disturbance (0.2% vs. 0.2%; p = 0.51) which were similar between sexes.Conclusion: Compared with male patients, female patients experience higher rates of cardiac, respiratory, gastrointestinal, and neurological symptoms within 1 month of AF ablation.

Aims: Reliable vascular access and haemostasis techniques are important to the safety of electrophysiology (EP) procedures. This European Heart Rhythm Association (EHRA) survey aimed to evaluate contemporary vascular access site management practices across international EP centres. Methods and results: A 30-question survey was disseminated via the EHRA between March and April 2025, with 401 responses from professionals across 51 countries. Most respondents were cardiology consultants/attendings (82.0%), with 57.3% performing over 150 EP procedures annually. Ultrasound guidance for vascular access was usually or always used by 71.7%, though 21.4% used it rarely or never, and only 17.3% had received formal ultrasound training. Institutional protocols for haemostasis were lacking in around half (46.8%) of centres. Suture-mediated closure was the most common method for haemostasis (60.4%), followed by manual compression (33.0%) and vascular closure devices (VCDs, 5.8%). The figure-of-eight suture with a hand-tied knot was the most frequently used suture technique (79.7%). Just over a third (36.0%) had experience with VCDs, typically reserved for high-risk cases. For procedures requiring transeptal access, 38.1% administered heparin before transeptal puncture, while protamine was rarely or never used by 62.1%. Anticoagulation was partially interrupted in 52.1% and continued uninterrupted in 41.1% of routine atrial fibrillation (AF) ablations. The median bed rest duration post-procedure ranged from 4 h (right-sided EP procedures) to 6 h (AF or left-sided EP procedures). The average quoted vascular complication risk during consent was 3% (inter-quartile range 1–5%). Conclusion: This survey highlights marked variation in vascular access site management during and following EP procedures, emphasizing the need for further clinical trials to inform best practice and guide future standardization efforts.

Background: Pulsed field ablation (PFA) of atrial fibrillation (AF) using a pentaspline multi-electrode catheter is commonly performed under fluoroscopic guidance. No data exist on the integration of this catheter within a three-dimensional electroanatomical mapping (3D-EAM) system for left atrial voltage and activation mapping, posterior wall isolation (PWI), or redo ablation. This technical report reviews an approach whereby mapping is performed using the pentaspline PFA catheter itself within an open architectural impedance–based 3D-EAM system. Methods: Cases involved mapping with the PFA catheter itself, with real-time visualisation of the guidewire tip and catheter within the 3D-EAM system. In certain cases, additional 3D-EAM was performed with a grid-style high-density mapping catheter for comparison. Results: In a series of 22 patients (45% female, mean age 63 ± 13 years, 55% paroxysmal AF, 27% redo procedures), mapping increased procedural times (mean 108 min vs. 68 min in fluoroscopy-only controls), without reducing fluoroscopy times. Three potential advantages of mapping with the PFA catheter were identified: (1) The technique helped identify sleeves of incomplete pulmonary vein isolation after index applications. (2) In the four cases mapped with both the PFA and grid-style catheters, voltage maps appeared concordant. (3) The technique helped facilitate robust PWI and identify inadvertent partial PWI. Conclusions: 3D-EAM with a pentaspline PFA catheter itself is feasible, without the need for high-density mapping catheters. This approach has potential advantages over fluoroscopic-only guidance, although its long-term efficacy and cost-effectiveness require formal assessment. Graphical

Introduction: Pulsed-field ablation (PFA) is a novel modality for pulmonary vein isolation in patients with atrial fibrillation (AF). We describe the initial uptake and experience of PFA using a pentaspline catheter across selected National Health Service England (NHSE) centres. Methods: Data collected by NHSE Specialised Services Development Programme regarding AF ablation procedures using a single-shot, pentaspline, multielectrode PFA catheter (FARAWAVE, Boston Scientific) between June 2022 and August 2024 were aggregated and analysed to examine procedural metrics, acute efficacy and safety outcomes over 3-month follow-up. Results: 1034 procedures were submitted. The patients were 32.1% female, mean age 63.8±10.7 years, 53.1% paroxysmal AF and 89.7% first-time AF ablation. Procedures were performed by 48 consultant operators at nine NHSE centres, with a mean of 115 procedures per centre (range 25–264). 93.7% of procedures were performed under general anaesthesia. Median skin-to-skin procedure time was 74 min (IQR 55–96 min) and fluoroscopy time 20 min (IQR 15–27 min). Electroanatomical mapping was used in 15.3%. In first-time ablation cases, acute isolation of all pulmonary veins was achieved in 99.5% of patients. Left atrial (LA) posterior wall ablation using the PFA catheter was performed in 11.0% of cases; additional LA radiofrequency ablation was performed in 0.6%. The major and minor acute procedural complication rates were, respectively, 1.3% and 3.1%, with no reports of periprocedural death or atrio-oesophageal fistula. 63.8% of patients were discharged on the day of procedure. Follow-up data were available for 870 procedures (84.1%). In the 3 months following ablation, hospitalisation for arrhythmia occurred in 3.2%, with 0.9% rehospitalised for procedural-related complications. Conclusion: In this real-world, nationwide registry of a pentaspline PFA catheter, efficacy, safety and efficiency outcomes were comparable to those from previous PFA studies in patients with AF.