Successful staged endocardial ablation using pulsed-field ablation for pulmonary vein-left atrium macroreentrant tachycardia after epicardial convergent procedure

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Pulmonary vein-left atrium macroreentrant tachycardia (n=1). Intervention: Pulsed-field ablation (PFA). Primary outcome: Termination of tachycardia and restoration of sinus rhythm.

Yae Min Park; Michael Jiang; Peyman Benharash; Justin Hayase

doi:10.18501/ija.2026.27.e4

January 1, 2026International Journal of ArrhythmiaOpen Access

Successful staged endocardial ablation using pulsed-field ablation for pulmonary vein-left atrium macroreentrant tachycardia after epicardial convergent procedure

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Key result

Pulsed-field ablation terminates PV-LA macroreentrant tachycardia and eliminates PV potentials following an epicardial convergent procedure.

n=1

Why the study?

The role of pulsed-field ablation in the convergent procedure for atrial fibrillation or atrial tachycardia remains unclear.

Key Points

To report the feasibility and efficacy of endocardial pulsed-field ablation for pulmonary vein-left atrium macroreentrant tachycardia following an epicardial convergent procedure.
Evaluated an 81-year-old male with long-standing persistent atrial fibrillation presenting with atrial tachycardia 3 months after epicardial convergent ablation.
Performed high-density 3D endocardial activation mapping to delineate the tachycardia circuit and localized conduction gaps across the left superior pulmonary vein.
Delivered endocardial pulsed-field ablation using a pentaspline catheter system targeting the conduction exit site.
Application of pulsed-field ablation at the earliest atrial activation site terminated the macroreentrant tachycardia and restored normal sinus rhythm.
Post-ablation voltage mapping demonstrated complete electrical isolation of all 4 pulmonary veins and the left atrial posterior wall without procedural complications.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 81-year-old male with a history of long-standing persistent atrial fibrillation who developed pulmonary vein-left atrium macroreentrant tachycardia 3 months after the epicardial portion of a convergent procedure.

I

Intervention

Endocardial catheter ablation using a pentaspline pulsed-field ablation (PFA) system (64 applications in basket and flower configurations at the four PVs, roof line, and inferior line).

O

Outcome

Termination of tachycardia and elimination of pulmonary vein potentials (restoration of sinus rhythm and complete electrical isolation of the 4 PVs and LA posterior wall).

Pulsed-field ablation is a feasible and effective modality for treating pulmonary vein-left atrium macroreentrant tachycardia during the endocardial phase of a staged convergent procedure.

Limitations

Single case report
Entrainment mapping was not performed
Aggressive induction testing was not performed due to advanced age
Longer follow-up with rhythm monitoring is necessary to confirm long-term efficacy
Requires longer follow-up with rhythm monitoring to confirm long-term efficacy and durability
Requires further prospective studies involving a large cohort of patients

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Implication

Supports feasibility of pulsed-field ablation for post-convergent macroreentry; hypothesis-generating and warrants prospective validation.

Abstract

The role of pulsed-field ablation (PFA) in convergent procedure for atrial fibrillation (AF)/atrial tachycardia remains unclear. We describe a case of a patient who developed pulmonary vein (PV)-left atrium macroreentrant tachycardia following the epicardial portion of convergent procedure for AF and subsequently underwent successful endocardial ablation using a pentaspline PFA system. The application of PFA successfully terminated the tachycardia and eliminated the PV potentials, thereby completing the convergent ablation procedure.

Discussion

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Cite This Study

Park et al. (2026) conducted a case report in Pulmonary vein-left atrium macroreentrant tachycardia (n=1). Pulsed-field ablation (PFA) was evaluated on Termination of tachycardia and restoration of sinus rhythm. Pulsed-field ablation successfully terminated pulmonary vein-left atrium macroreentrant tachycardia and eliminated pulmonary vein potentials following an epicardial convergent procedure.

synapsesocial.com/papers/6a025a9a9cddff7633412dcd https://doi.org/10.18501/ija.2026.27.e4

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Successful staged endocardial ablation using pulsed-field ablation for pulmonary vein-left atrium macroreentrant tachycardia after epicardial convergent procedure

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Successful staged endocardial ablation using pulsed-field ablation for pulmonary vein-left atrium macroreentrant tachycardia after epicardial convergent procedure

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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