Zero‐fluoroscopy ablation with multielectrode pulse field ablation system: Case series

Abstract

Pulse field ablation (PFA) is a novel nonthermal ablation modality for treatment of atrial fibrillation. While mostly lacking 3D electroanatomical mapping integration, reported radiation doses in procedures using multielectrode PFA catheters are relatively high. We report a first case series of three patients where a zero‐fluoroscopy approach by intracardiac echocardiography was utilized and present a possible workflow for zero‐fluoroscopy ablation with the Farapulse PFA system.

Ablation of Paroxysmal Atrial Fibrillation: between Present and Future

“…We expect a better knowledge of PFA and its integration in 3D-mapping systems (e.g., FARAPULSE™+RHYTHMIA HDx, Boston Scientific; VLCC/PFA generator+CARTO 3, Biosense Webster; and VOLT™, Abbott) in order to reduce or remove fluoroscopy and at the same time deliver precise point-by-point energy by tagging lesions, looking at gaps, and also the possibility to switch between PFA and RF (e.g., AFFERA™ Medtronic) [ 85 , 86 ]. To this extent, intracardiac echography (ICE) may allow us to reduce or even abolish the use of fluoroscopy for PVI via PFA, as recently reported in a small case series [ 87 ]. On the other hand, ICE already allows complete zero-fluoro AF ablation via point-by-point RF [ 53 , 88 ].…”

New Frontiers in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders

“…Another ablation method is cryoablation, which may be especially valuable in pulmonary vein isolation and in patients with perinodal accessory pathways due to the low risk of persistent iatrogenic atrioventricular block [16]. Moreover, the use of pulse field ablation also holds great promise, which is a novel ablation modality utilizing non-thermal energy and causing irreversible electroporation, leading to cardiac cell death (other cells are less prone to these changes) [17,18]. Among patients who experience recurrent ventricular tachycardias after catheter ablation despite optimal pharmacotherapy 2 of 5 or among those who have contraindications to catheter ablation, stereotactic arrhythmia radioablation is a potentially valuable treatment option [19].…”