Enhancing Safety and Efficacy in AF – Variable Loop-Guided PVI | RIO 2024 US Focus

Chair Bradley Knight (Chicago, US) led a session on enhancing safety and efficacy in atrial fibrillation ablation, focusing on variable loop-guided pulsed field ablation (PFA) for pulmonary vein isolation (PVI). The case was presented by Moussa Mansour (Massachusetts General Hospital, Boston, US), with panellists Rodney Horton (Austin, US) and Oussama Wazni (Cleveland, US). Mansour demonstrated the use of a newly FDA-approved PFA catheter from the Polaris study, which allows for voltage mapping and ablation. The catheter features a tissue proximity index to confirm contact and the ability to deactivate selected electrodes for targeted lesion delivery. The discussion covered integration with electroanatomical mapping, optimising electrode positioning, and reducing unnecessary ablation to minimise risks such as hemolysis. The faculty also explored the catheter’s versatility, including its use for posterior wall ablation and antral lesion creation. They debated the necessity of adjunctive tools such as intracardiac echo, coronary sinus catheters, and oesophageal temperature probes, concluding that while PFA reduces the need for some traditional safety measures, a cautious approach remains essential. The session highlighted the paradigm shift PFA introduces in atrial fibrillation treatment and the catheter’s potential for streamlining procedures while maintaining efficacy and safety.