SPC365

Feasibility and Tolerability of Pulsed-Field Ablation for Atrial Fibrillation Using the VOLT™ System Under Conscious Sedation: A Real-World Experience

Session: Sessão de Posters 05 - Ablação por campo pulsado: da viabilidade à fisiologia
Speaker: Joana Certo Pereira

Congress: CPC 2026
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Joana Certo Pereira; Rita Almeida Carvalho; Francisco Moscoso Costa; Daniel A. Gomes; Gustavo Rodrigues; Daniel Matos; João Carmo; Pedro Galvão Santos; Pedro Carmo; Francisco Belo Morgado; Diogo Cavaco; Pedro Adragão

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pulsed-field ablation (PFA) is an emerging, for atrial fibrillation (AF) ablation, allowing safer and shorter procedures but requiring deep sedation or general anaesthesia. The newly introduced VOLT&trade; mapping and ablation system (Abbott&trade;), with the balloon-in-basket design and bipolar energy delivery, enables more efficient lesion formation with a simplified workflow, potentially reducing acute procedural pain and requiring lower levels of sedation. Data on feasibility under conscious sedation remain limited.&nbsp;</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study aimed to evaluate procedural performance, anesthetic management, and acute safety outcomes in patients undergoing AF ablation using this technology. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single-center registry included patients who underwent AF ablation using the VOLT&trade; system between June and November 2025. Patient selection for conscious sedation followed predefined criteria: BMI &lt;30 kg/m&sup2;, low procedural anxiety, prior successful procedures under sedation, anticipated procedure time &lt;45 minutes, and absence of significant obstructive sleep apnea or chronic lung disease. Sedation protocols included midazolam, remifentanil, and dexmedetomidine, with adjunctive propofol in selected cases. Procedural duration, fluoroscopy time, acute success, and complications were recorded.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 43 patients were included (mean age 61 &plusmn; 10 years, 63% male, 72% with paroxysmal AF, 21% Redo procedures). Mean procedure duration was 64 &plusmn; 22 min and fluoroscopy time was 10 &plusmn; 6 min. The mean number of PVI applications per patient was 19 &plusmn; 9, and additional lesions averaged 7 &plusmn; 9 applications. Twenty-four patients (56%) underwent PVI-only procedures while and the reminder (44%) required PVI plus additional lesions&ndash; figure 1. Complete acute PVI was achieved in all cases. No major periprocedural complications were observed.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">General anesthesia was used in 35% of cases, while 65% were performed under conscious sedation. The most used conscious sedation regimen included dexmedetomidine + midazolam + remifentanil (n= 20; 71%). In the conscious sedation group, no remapping was required due to patient movement during energy application, nor were there conversions to general anesthesia. In two cases, sedation was temporarily deepened to a non-conscious level due to discomfort/anxiety. Overall, pain and discomfort were minimal, and operators reported preserved catheter stability throughout the procedures.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong></span></span></p>

<p><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">In our initial experience, the VOLT&trade; system demonstrated high acute efficacy and a favorable safety profile. </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Procedures performed under conscious sedation were feasible, well tolerated, and efficient, with complete acute success and no complications. These real-world findings supports conscious sedation as a feasible alternative to general anaesthesia, potentially facilitating same-day workflows and optimizing resource utilization in AF ablation programs.</span></span></p>