Unexpected ventricular fibrillation triggered by pulsed field ablation for atrial fibrillation

Figures

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  Figure 1. A: Activation map showing the perimitral flutter and the posterior mitral line performed. B: Activation map and the catheter position during the application inducing ventricular fibrillation. C: Ventricular fibrillation occurrence during delivery of pulsed field energy.

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  Figure 2. A: Electrocardiogram (ECG) in sinus rhythm, 6 months prior ablation, showing T-wave abnormalities attributed to pacemaker-related T-wave memory. B: ECG the day before ablation showing atypical flutter. C: ECG before ventricular fibrillation occurrence, showing similar pacemaker-related T-wave memory changes. D: ECG after defibrillation, showing similar T-wave abnormalities.

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  Figure 3. A: Coronary angiography showing stenosis in the proximal circumflex artery (red arrow). B: Fusion image of coronary angiography and electroanatomic mapping (right anterior oblique 14°, caudal 13° projection), indicating the ablation site located remotely from the circumflex stenosis (red arrow). C: Fusion image of coronary angiography and electroanatomic mapping in another projection (left anterior oblique 36°, cranial 30° projection), showing the mitral isthmus located remotely from the circumflex stenosis (red arrow).