{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:10:30Z","timestamp":1792642230157,"version":"4.5.0"},"reference-count":23,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The VARIPULSE platform is an advanced Pulsed Field Ablation (PFA) system fully integrated with electro-anatomical mapping system, employing a variable loop circular catheter (VLCC) for atrial fibrillation (AF) ablation. The objective of the study is to assess for the first time the feasibility, safety, and procedural impact of AI (artificial intelligence)-assisted ICE (intracardiac echocardiography) mapping with the CARTOSOUND FAM Module compared with conventional electroanatomical mapping during PFA. Methods: In this retrospective, multicenter study, 157 consecutive patients undergoing PFA for paroxysmal or persistent AF were included. Patients were divided into two groups: ICE-guided cohort (n = 64) and non-ICE-guided cohort (n = 93). Propensity score matching (PSM) was used to adjust for baseline differences. Results: AI-assisted ICE mapping was feasible in all cases. Compared with conventional mapping, it significantly reduced LA (left atrium) mapping time (median 5 vs. 8 min; p &lt; 0.001), LA dwell time (33.5 vs. 38.5 min; p = 0.001), and fluoroscopy time (7.5 vs. 14 min; p &lt; 0.001). The total number of PFA applications was similar across groups (p = 0.136). No major adverse events occurred in either cohort during the procedure or within the first month of follow-up. Conclusions: AI-assisted ICE mapping using the CARTOSOUND FAM Module enables accurate anatomical reconstruction and significantly optimizes procedural efficiency in PFA. This approach supports further development toward radiation-sparing and potentially fluoroscopy-free PFA workflows. For the first time, it addresses a gap in the current evidence regarding the use of ICE in PFA, building on evidence already established for radiofrequency ablation procedures.<\/jats:p>","DOI":"10.3390\/jcm14207249","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T11:57:42Z","timestamp":1760529462000},"page":"7249","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["AI-Assisted 3D Intracardiac Echocardiography for Pulsed Field Ablation of Atrial Fibrillation Using a Novel Variable Loop Circular Catheter: A Multicenter Evaluation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7737-421X","authenticated-orcid":false,"given":"Antonio","family":"Dello Russo","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0454-0739","authenticated-orcid":false,"given":"Yari","family":"Valeri","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Ciconte","sequence":"additional","affiliation":[{"name":"Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"},{"name":"Department of Arrhythmology, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Schiavone","sequence":"additional","affiliation":[{"name":"Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-6548","authenticated-orcid":false,"given":"Paolo","family":"Compagnucci","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-2056","authenticated-orcid":false,"given":"Antonio","family":"Di Monaco","sequence":"additional","affiliation":[{"name":"Cardiology Department, Regional General Hospital \u201cF. Miulli\u201d, Acquaviva delle Fonti, 70021 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Riva","sequence":"additional","affiliation":[{"name":"Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8433-692X","authenticated-orcid":false,"given":"Raffaele","family":"Salerno","sequence":"additional","affiliation":[{"name":"Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"},{"name":"Department of Arrhythmology, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Volpato","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7570-4278","authenticated-orcid":false,"given":"Laura","family":"Cipolletta","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8060-379X","authenticated-orcid":false,"given":"Quintino","family":"Parisi","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"Department of Clinical, Special, and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy"},{"name":"Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Cardiology Department, Regional General Hospital \u201cF. Miulli\u201d, Acquaviva delle Fonti, 70021 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8500-8313","authenticated-orcid":false,"given":"Claudio","family":"Tondo","sequence":"additional","affiliation":[{"name":"Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Pappone","sequence":"additional","affiliation":[{"name":"Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"},{"name":"Department of Arrhythmology, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Oikawa, J., Fukaya, H., Kanaoda, K., Niwano, S., Miyamoto, K., Iwanaga, Y., Iwasaki, Y., Nagashima, K., Masuda, M., and Yamashita, S. 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