Real World First Experience Using a 122 Electrode Spherical Array Pulsed Field Ablation Catheter

Abstract 2303064, presented at Western Atrial Fibrillation Symposium 2026

To describe the real-world experience of a first-time spherical array catheter user conducting his first case. A novel “single-shot” map and ablate 122-electrode spherical array pulsed field ablation (PFA) array catheter has been FDA approved after successful completion of the PULSAR IDE trial demonstrating safe and effective pulmonary vein isolation (PVI) for the treatment of paroxysmal atrial fibrillation. Overlake Medical Center has conducted the first commercial procedure in Western USA using the spherical array catheter.A patient with atrial fibrillation underwent PVI and posterior wall (PW) homogenization. Acute safety, efficacy, and procedural results are outlined.A 44 year-old man with persistent atrial fibrillation refractory to propafenone underwent PVI and PW homogenization under GA using a zero-fluoroscopy workflow without any prior imaging. An integrated mapping system rendered left atrial anatomy, voltage, and local activation time (LAT). Temperature-based contact assessment was used to confirm contact at the pulmonary vein (PV) antrum prior to the ablation application at each vein. One PFA application was used per PV, with all veins showing acute success after a single application on electrogram and voltage mapping. Transpired PV ablation time was 8 minutes from the start of the first PV ablation to the end of the last PV ablation. PW homogenization was then conducted using 5 ablation applications in different positions, using system parameters to identify and treat the PW with the specific electrodes in contact with the PW, which took 8 minutes from the start of the first ablation application to the end of the last ablation application. A post ablation map was created showing left atrial voltage and LAT maps. Left atrial dwell time was 28 minutes total. The patient was discharged with no complications and, at least initially, has maintained sinus rhythm.This case demonstrates safe and efficient real-world use of the spherical array catheter in a first-time user's first procedure with the spherical array catheter, without significant learning curve or need for pre-procedure imaging or fluoroscopy.