Voltage threshold adjustments for a novel pulsed-field ablation catheter with integrated mapping capabilities: lessons from a case series
Abstract
Abstract Background Accurate electroanatomical mapping relies on voltage thresholds to differentiate electrically inactive areas, fibrotic scar, and healthy myocardium. These thresholds have been well established for high-density mapping catheters with small, closely spaced electrodes. However, the optimal voltage thresholds for a novel pulsed-field ablation catheter with integrated mapping capabilities remain unclear. This case series evaluates different voltage thresholds for the variable-loop circular catheter (VLCC, Varipulse, Biosense Webster) compared with a dedicated high-density mapping catheter (Octaray, Biosense Webster). Case summary Four patients undergoing left atrial catheter ablation—including pulmonary vein isolation (PVI), posterior wall ablation, and ablation for scar-related atrial flutter—were mapped using both the VLCC and Octaray catheter. The key findings include: (i) standard voltage thresholds for high-density catheters overestimate voltage in scarred and ablated tissue when applied to the VLCC, necessitating adjusted voltage settings; (ii) the VLCC effectively identified PVI and reconnections, posterior wall isolation, anterior wall scarring, and atrial flutter circuits; and (iii) while the VLCC identified areas of scar, its representation remained less precise compared with high-density mapping. Discussion This case series demonstrates that the VLCC provides satisfactory mapping performance in common use cases but requires voltage threshold…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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