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PO-04-270 ZERO-EXCHANGE WORKFLOW WITH A VARIABLE LOOP PFA CATHETER AND NO DEDICATED MAPPING CATHETER IMPROVES PROCEDURAL EFFICIENCY
Abstract   Peer reviewed

PO-04-270 ZERO-EXCHANGE WORKFLOW WITH A VARIABLE LOOP PFA CATHETER AND NO DEDICATED MAPPING CATHETER IMPROVES PROCEDURAL EFFICIENCY

Mark D. Metzl, Jeremiah Wasserlauf, Nikhil Joshi, Daniela Hincapie Tabares, Chang Dai, Christopher P. Porterfield, Paari Dominic, Sandeep Gautam, David A. Steckman, Edward Powers, …
Heart rhythm, Vol.23(4 Supplement), pp.S748-S749
04/2026
DOI: 10.1016/j.hrthm.2026.03.1267

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Abstract

Background Pulsed field ablation (PFA) with the Variable Loop Circular Catheter (VLCC) continues to modernize atrial fibrillation (AF) workflows. A key decision point in real-world practice is whether to incorporate a dedicated mapping catheter. Understanding performance across these workflows is essential for centers with diverse resource levels and procedural techniques. Objective To analyze acute safety and efficiency in procedures without an additional mapping catheter. Methods We performed an interim analysis of consecutive VLCC PFA in REAL AF between March and November 2025. Procedure workflows were compared between 2 groups: a separate mapping catheter was used vs not used. In the group without a mapping catheter, mapping was performed using the VLCC. Results There were 597 patients with complete mapping approach datas. Patients were similar across groups (see Table). Lesion strategy was similar between both approaches (60.73% vs 61.43% PVI alone, p=0.863). Procedure duration (62.93 ± 25.52 vs 93.79 ± 77.70 minutes, p<0.001) was shorter with fewer PFA applications (29.30 ± 19.56 vs 39.80 ± 26.14, p<0.001) and a high proportion of zero-fluoroscopy (72.87% vs 52.57%, p<0.001) cases in the without mapping catheter group. Acute efficacy was high in both groups: all veins were isolated in 100.00% vs 99.12% of cases (p=0.145). Same-day discharge occurred in 87.97% vs 83.14% (p=0.106). Acute safety events were rare (0.41% vs 0.57%, p=0.777). Conclusion This interim analysis demonstrates broad adoption of workflows with and without a mapping catheter, reflecting the system’s versatility to support diverse procedural strategies. Procedures without a mapping catheter were frequently zero-fluoroscopy, associated with shorter procedure times, high acute success, and no observed complications. Ongoing follow-up will evaluate longer-term safety and durability across these distinct yet complementary workflows.

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