ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026
Real-world strategies for pulsed field ablation using a variable-loop circular catheter: a compendium of best practices from early adopters.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe VARIPULSE™ variable loop circular (VLCC) pulsed field ablation (PFA) catheter was approved by the Food and Drug Administration in November 2024 to treat symptomatic paroxysmal atrial fibrillation (PAF). As catheter adoption increases, systematically sharing best practices can highlight its versatility across diverse workflows. This initiative aimed to synthesize real-world strategies from experienced operators, creating a consensus compendium that highlights reproducible core elements and flexible variations that make the VLCC system adaptable across diverse practice styles.
methodsAn iterative workflow development process was conducted in collaboration with electrophysiologists (EPs) from high-volume sites. To ensure diversity, we invited 26 of the top 50 highest-volume U.S. operators (no > 1 per clinic by design).
resultsTwenty-six EPs experienced in performing PFA with the VLCC were invited; 12 responded to an online survey, 11 participated in one of three virtual consensus workshops during June-July 2025. Participants collectively represented > 10% of current U.S. commercial procedures (> 700 cases in aggregate) and included three of the top five users. Data collected revealed common patterns of practice, including the use of general anesthesia, intracardiac echocardiography (ICE), ablation strategies, zero-fluoroscopy workflows, and posterior wall ablation (PWA) performed within established safety parameters.
conclusionThis consensus-informed initiative establishes a practical framework for a compendium of strategies for the VLCC system. The compendium reflects areas of strong alignment among experienced operators and offers preliminary procedural guidance that may support clinical decision-making as adoption expands. As real-world experience grows, this compendium serves as a reference point for ongoing refinement and future workflow optimization.
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