Pulsed-field ablation (PFA) is a newer energy delivery method, an alternative to thermal lesion, allowing for safe and durable pulmonary vein isolation in the context of atrial fibrillation ablation. Graded tissue sensitivity allows for specifically targeting atrial cardiomyocytes, rendering collateral damage to nearby nerves and vessels unlikely. In the present rapid communication, we report on our center's initial experience with a novel PFA platform and describe the ways in which it can be used targeting sites beyond PV ostia and antra, in the context of atrial fibrillation/flutter/tachycardia ablation, alone or in conjunction with a mainstream 3-dimensional electroanatomical mapping system (3D-EAM). More specifically, the exploratory application of PFA in the vicinity of pacemaker/defibrillator leads may prove of particular significance for clinical practice, given the frequent need to isolate the superior vena cava in patients bearing a transvenous cardiac rhythm management device.
Keywords: atrial fibrillation; cavotricuspid isthmus; electroanatomical mapping; fixed-loop catheter; posterior wall isolation; pulsed-field ablation.
Atrial fibrillation is a common arrhythmia. It can be treated by carefully destroying specific areas of the heart. Pulsed field ablation is a new energy delivery method that selectively destroys heart cells by causing an electrical shock. In this article, we describe our initial experience with such a system used in treating many different arrhythmias. Moreover, this system can be used with a Global Positioning System-like platform so that we can see the position of our tools inside the heart in real time, increasing safety and improving results.