Pulsed field ablation of the cavotricuspid isthmus using a multispline-electrode pulsed field ablation catheter

Key Teaching Points•Pulsed field ablation (PFA) is a promising method for pulmonary vein isolation (PVI).•Atrial fibrillation and coexisting cavotricuspid isthmus (CTI) flutter is a common problem and PVI and CTI ablation is often performed in the same procedure.•In this case we describe the successful use of the multispline-electrode PFA catheter for PVI and supplementary ablation of the CTI in a patient with acquired atrioventricular block and cardiac resynchronization therapy-defibrillator.•High-resolution voltage and propagation maps after PFA in the CTI showed extensive low voltage on the CTI region but normal voltage in the triangle of Koch and coronary sinus and lateral to the CTI. •Pulsed field ablation (PFA) is a promising method for pulmonary vein isolation (PVI).•Atrial fibrillation and coexisting cavotricuspid isthmus (CTI) flutter is a common problem and PVI and CTI ablation is often performed in the same procedure.•In this case we describe the successful use of the multispline-electrode PFA catheter for PVI and supplementary ablation of the CTI in a patient with acquired atrioventricular block and cardiac resynchronization therapy-defibrillator.•High-resolution voltage and propagation maps after PFA in the CTI showed extensive low voltage on the CTI region but normal voltage in the triangle of Koch and coronary sinus and lateral to the CTI.