Pulsed field ablation for pulmonary vein and left atrial posterior wall isolation in persistent atrial fibrillation: a narrative review

Figures

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  Figure 1.. Validation of LAPW isolation using 3D mapping in de novo and redo cases, with Panel (A) showing Rhythmia mapping and Panel (B) NavX validation. Conduction gaps were identified during coronary sinus pacing, with further assessment through voltage and activation mapping.

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  Figure 2.. Following PVI, LAPW isolation was performed at the operator’s discretion using PFA to create continuous lesions linking the floor, roof, and inner wall of the LAPW, with additional ablation applied at carina sites when necessary. Panel (A) shows a CT reconstruction of the left atrium, Panel (B), a 3D-mapping reconstruction, and Panel (C), a fluoroscopic visualization of the LAPW ablation process.

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  Figure 3.. Lesion formation and residual gaps were analyzed by dividing PV encircling lines into seven sections and the LAPW into nine regions. Panel (A) highlights gap locations for PVs (red dots) and LAPW (yellow dots), Panel (B) shows residual atrial activity in the LAPW, and Panels (C) and (D) provide additional views of LAPW isolation results.

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  Figure 4.. Kaplan–Meier curves illustrating arrhythmia recurrence rates during follow-up, stratified by ablation strategy, with red indicating PVI-only and blue PVI + LAPWI.

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  Figure 5.. Electroporation selectivity illustrated by concentration of the electrical field within the ablation zone, with sparing of adjacent structures such as the esophagus and phrenic nerve.

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  Figure 6.. Kaplan–Meier curve illustrating AF-free survival following ablation. The figure demonstrates how PFA performs over time compared with other ablation methods.

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  Figure 7.. Procedural success and complication rates associated with PFA ablation are shown. The figure highlights the efficiency and safety advantages of PFA compared with conventional approaches.