Pulsed field ablation for complex variant pulmonary vein and posterior wall isolation using the Varipulse catheter: a case report

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  Figure 1. Posterior-anterior (A) and superior (B) computed tomography–based 3D reconstruction of the pulmonary veins. The inferior pulmonary veins join posterior to the left atrium, forming a ‘common inferior ostium’. (C) Posterior-anterior (C) and left-lateral (D) voltage mapping prior to catheter ablation of the left atrium. Confluent areas of low voltage (<0.5 mV) are seen along the ‘common ostium’ and the posterior wall. (E) Posterior-anterior view of the left atrium showing the ostial pulsed field ablation lesions as well as the Varipulse catheter oriented towards the ‘common ostium’. (F) Posterior-anterior view of the left atrium showing the voltage map together with the ablation grids (in purple) following ablation. There is an absence (<0.01 mV) of local signals in the posterior wall in addition to the pulmonary vein ostia.