The Olive Strategy: Improved Pulmonary Vein Isolation Durability With the Pentaspline Pulsed Field Catheter

Abstract

Background: The pentaspline pulsed field ablation (PFA) catheter is rapidly gaining popularity as a tool for pulmonary vein isolation (PVI). Its standard ablation protocol recommends applying 8 applications per pulmonary vein (PV) with 2 different catheter configurations: the flower and the basket shape. Using this protocol, the rate of durably isolated PVs during repeat procedures is not superior to that after conventional thermal PVI.

Objectives: This study aimed to improve PVI durability with the pentaspline PFA catheter through an extension of the ablation protocol and the introduction of a novel catheter shape.

Methods: The authors added 2 applications in a small olive-shaped catheter configuration, leading to a total of 10 applications per PV. Procedural data, safety data, and remapping data from patients undergoing repeat procedures and clinical outcomes were analyzed.

Results: A total of 400 consecutive patients were treated with the new olive strategy. In patients undergoing repeat procedures, PV reconnection was significantly less frequent after PVI with the olive strategy (13.6% [3 of 22 patients]) than after the conventional strategy (45% [36 of 80 patients]; P = 0.007). Procedure-related complications occurred in 11 (2.75%) of 400 patients. Comparison of 100 patients treated with the olive strategy vs 100 propensity score-matched conventional patients found no difference in freedom of arrhythmia at 180 days after the procedure (olive strategy: 86%; conventional strategy: 87.3%; P = 0.75).

Conclusions: The authors report on the initial clinical experience of a novel ablation protocol for PVI with the pentaspline PFA catheter. The Olive Strategy is safe to use and significantly improves PVI durability.

Keywords: atrial fibrillation; catheter ablation; pulmonary vein isolation; pulsed field ablation.