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.

What question did this study set out to answer?

To evaluate the effectiveness of pulsed-field ablation in treating pulmonary vein-left atrium macroreentrant tachycardia following a convergent procedure.

February 28, 2026International Journal of Arrhythmia0 citationsOpen Access

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

YPYae Min ParkRonald Reagan UCLA Medical Center MJMichael JiangRonald Reagan UCLA Medical Center PBPeyman BenharashCardiac Surgery

Key Result

Pulsed-field ablation successfully terminated pulmonary vein-left atrium macroreentrant tachycardia and eliminated pulmonary vein potentials following an epicardial convergent procedure.

Key Points

To evaluate the effectiveness of pulsed-field ablation in treating pulmonary vein-left atrium macroreentrant tachycardia following a convergent procedure.
Descriptive case of a patient post-epicardial convergent procedure for atrial fibrillation.
Successful endocardial ablation was performed using a pentaspline pulsed-field ablation system.
Application aimed to terminate tachycardia and eliminate pulmonary vein potentials.
Pulsed-field ablation successfully terminated the macroreentrant tachycardia.
Elimination of pulmonary vein potentials was achieved, completing the convergent ablation procedure.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

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.

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).

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

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.

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