Ventricular Fibrillation Immediately Following Pulsed Field Energy Delivery in Persistent Atrial Fibrillation

Figures

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  Figure 1. Ventricular fibrillation occurring immediately after pulsed field energy delivery. A: Surface electrocardiogram and intracardiac recordings demonstrating ventricular fibrillation occurring immediately after the first pulsed field application delivered to the posterior wall near the right inferior pulmonary vein. Intracardiac electrograms obtained before the PFA application demonstrate large near-field atrial signals with only small far-field ventricular components (asterisk), suggesting a substantial distance between the ablation site and the left ventricle. B: Fluoroscopic image showing the catheter position at the site of pulsed field energy delivery associated with ventricular fibrillation onset. C: Posteroanterior projection of the postablation left atrial voltage map showing broad low-voltage areas on the posterior wall. The site of the pulsed field application that induced ventricular fibrillation (yellow arrowhead) is located at a substantial distance from the left ventricle. PFA = pulsed field ablation.

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  Figure 2. 12-lead electrocardiograms before ablation and after successful external defibrillation. A: Baseline electrocardiogram showing sinus rhythm with a QRS duration of 98 ms and no ST–T-segment abnormalities. B: Postdefibrillation electrocardiogram demonstrating restoration of sinus rhythm without ST–T-segment changes compared with baseline.