Pulsed-Field Ablation for Incessant Atrial Tachycardia Originating From the Left Atrial Appendage Apex

Figure 1. 12-Lead Electrocardiogram During the Patient's Admission (A) Presenting rhythm. (B) Normal sinus rhythm after pulsed-field ablation.

Figure 2. Mapping and Location of Tachycardia (A) Three-dimensional electroanatomic mapping using a circular mapping catheter localizes the earliest atrial activation site during tachycardia at the ostium of the left atrial appendage. (B) Activation mapping with a magnetically guided, contact force–sensing focal pulsed-field ablation catheter; the earliest activation site was localized at the apex of the left atrial appendage. (C) Fluoroscopic image of the left atrial appendage angiography. (D) Catheter position during ablation within the left atrial appendage.

Figure 3. Ablation of Atrial Tachycardia Using a Pulsed-Field Ablation Catheter (A) A pulsed-field ablation catheter was positioned at the preidentified earliest activation site for ablation delivery. (B) This ablation attempt successfully terminated the atrial tachycardia. (C and D) Nine additional pulsed-field ablation applications were subsequently administered to the tissue surrounding the target site to ensure adequate lesion coverage.

Figure 4. Electrophysiological Study After Atrial Tachycardia Ablation (A and B) After ablation, aggressive burst atrial stimulation failed to induce any tachycardia, confirming successful elimination of the arrhythmogenic focus.