Sequential radiofrequency–pulsed field ablation of a refractory right posteroseptal accessory pathway using a dual-energy catheter

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Wolff-Parkinson-White syndrome (n=1). Intervention: Sequential radiofrequency and pulsed field ablation. Primary outcome: Pathway elimination.

Maicol Cortez-Sandoval; Rodolfo San Antonio; Jesús Rodríguez-Silva; Alex Carrasco; Julián Rodríguez-García; Andrea Di Marco; Paolo D Dallaglio; Ignasi Anguera

doi:10.1007/s10840-026-02374-y

June 15, 2026Journal of Interventional Cardiac ElectrophysiologyOpen Access

Sequential radiofrequency–pulsed field ablation of a refractory right posteroseptal accessory pathway using a dual-energy catheter

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Key result

Low-energy PFA after transiently successful RF ablation eliminates a refractory right posteroseptal accessory pathway.

n=1

Key Points

To describe the elimination of a refractory right posteroseptal accessory pathway with deep intramural course using a sequential radiofrequency and pulsed field ablation strategy.
Evaluated a 26-year-old man with Wolff-Parkinson-White syndrome using electrophysiological study and electroanatomic mapping in sinus rhythm.
Delivered radiofrequency energy at 40 W (maximum 43 °C, up to 60 s) via an irrigated dual-energy catheter, followed by rescue low-energy pulsed field ablation at the identical target site.
Radiofrequency applications repeatedly abolished pre-excitation after approximately 10 s, but pathway conduction consistently recurred upon energy cessation.
Low-energy pulsed field ablation delivered at the same validated ventricular exit produced immediate pathway elimination that remained durable during post-ablation waiting and follow-up.
Post-ablation mapping demonstrated a localized low-voltage lesion separated from the His bundle (target located approximately 9 mm from His) without atrioventricular block.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 26-year-old man with manifest Wolff-Parkinson-White syndrome and a refractory right posteroseptal accessory pathway treated with sequential radiofrequency and pulsed field ablation.

I

Intervention

Sequential radiofrequency (RF) ablation (40 W, maximum 43 °C, up to 60 s) followed by low-energy pulsed field ablation (PFA) at the same site using an irrigated dual-energy catheter (TactiFlex Duo Ablation Catheter).

O

Outcome

Immediate and durable pathway elimination (abolition of pre-excitation)

Sequential radiofrequency followed by pulsed field ablation using a dual-energy catheter successfully and safely eliminated a refractory right posteroseptal accessory pathway.

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Implication

May offer bailout for refractory pathways; hypothesis-generating and requires prospective validation before practice change.

Abstract

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Cite This Study

Cortez-Sandoval et al. (2026) conducted a case report in Wolff-Parkinson-White syndrome (n=1). Sequential radiofrequency and pulsed field ablation was evaluated on Pathway elimination. Sequential low-energy pulsed field ablation delivered after transiently successful radiofrequency ablation achieved immediate and durable elimination of a refractory right posteroseptal accessory pathway.

synapsesocial.com/papers/6a31586baf7cf7f8256b3e56 https://doi.org/10.1007/s10840-026-02374-y

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Sequential radiofrequency–pulsed field ablation of a refractory right posteroseptal accessory pathway using a dual-energy catheter

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sequential radiofrequency–pulsed field ablation of a refractory right posteroseptal accessory pathway using a dual-energy catheter

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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