# Single-Center Real World Experience with the VARIPULSE Platform for Pulsed Field Ablation of Atrial Fibrillation, Atrial Flutter, and Redo Procedures

## TL;DR

This study shows that the VARIPULSE catheter is effective and safe for treating atrial fibrillation and flutter using pulsed field ablation.

## Contribution

The study provides real-world evidence of the VARIPULSE catheter's use for non-pulmonary vein ablation in complex arrhythmias.

## Key findings

- VARIPULSE catheter successfully mapped and ablated non-pulmonary vein targets in 76.7% of patients.
- Atrial flutter was terminated in 27 out of 28 patients using the VARIPULSE catheter.
- No major complications were observed during the procedures.

## Abstract

Background/Objectives: Pulsed field ablation (PFA) is increasingly used for pulmonary vein isolation (PVI). One of the emerging single-shot PFA catheters is the variable-loop circular catheter (VARIPULSE™, Biosense Webster, Inc.) which is fully integrated into a three-dimensional mapping system. However, the evidence for the feasibility of ablation of non-pulmonary vein targets is still limited using the VARIPULSE catheter. In this study, we summarize our experience in PVI and mapping/ablation of non-pulmonary vein sites in patients with atrial fibrillation (AF) and complex atrial substrate and arrhythmias using the VARIPULSE catheter. Methods: All patients with paroxysmal or persistent AF who underwent catheter ablation using the VARIPULSE catheter were retrospectively included. PVI was performed in all patients. Spontaneous or inducible atrial flutters were mapped and ablated. Empiric lines were performed at the operator’s discretion. Acute outcomes and complications were analyzed. Results: the study included 60 patients; 25 (41.6%) were females and mean age was 67.15 ± 9.01 years. Thirty four (60%) had persistent AF and six (10%) patients had atrial flutter as the initial rhythm during the index procedure. All patients had PVI using the PFA as per protocol. Most of the patients (76.7%) had non-pulmonary vein ablation sites; posterior wall isolation was performed in 25 (41.7%) patients, roof line in 9 (15%) patients, anterior line in 16 (26.7%) patients, cavotricupsid isthmus in 11 (18.3%) patients and superior vena cava isolation in two (3.3%) patients. Overall, 27 patients had atrial flutters during the index procedure that were mapped and ablated using the VARIPULSE catheter. All had termination of atrial flutter except for one patient. Major complications were not detected. Conclusions: Mapping and ablation of atypical atrial flutter and non-pulmonary vein targets are feasible and safe using the VARIPULSE platform.