Key result
PFA successfully eliminates persistent AF and concurrent AVRT, restoring sinus rhythm with 3-month reverse remodeling.
Why the study?
Pulsed field ablation is increasingly adopted for atrial fibrillation due to its precision and safety, but its use for accessory pathway ablation during AF ablation is not well documented.
Does pulsed field ablation safely and effectively treat concomitant atrial fibrillation and atrioventricular reentrant tachycardia under tubeless general anesthesia?
Case Report (n=1)
No
Does pulsed field ablation safely and effectively treat concomitant atrial fibrillation and atrioventricular reentrant tachycardia under tubeless general anesthesia?
Pulsed field ablation appears to be an effective and safe approach for simultaneously treating persistent atrial fibrillation and an accessory pathway during a single tubeless procedure.
Supports feasibility of tubeless pulsed field ablation for concomitant persistent AF and AVRT in select cases; leaves open need for prospective validation.
Background: Radiofrequency ablation (RFA) combined with left atrial appendage closure (LAAC) has long been used in the treatment of atrial fibrillation (AF). Pulsed field ablation (PFA) is now increasingly adopted due to its great precision and improved safety profile. This report presents a rare case of PFA performed for persistent AF and atrioventricular reentrant tachycardia (AVRT), along with LAAC, under non-intubated general anesthesia. Case Description: -VASc score of 3 and a HAS-BLED score of 1. A one-stop procedure combining PFA and LAAC was planned. During ablation at the roof of the right superior pulmonary vein, AF converted to sinus rhythm and subsequently developed spontaneous tachycardia, suspected to be AVRT due to a left-sided accessory pathway near CS1-2. Therefore, ablation of the accessory pathway and mitral isthmus was performed, and atrioventricular separation and mitral isthmus block were confirmed. A total of 78 discharges were delivered throughout the procedure, and repeated high-frequency atrial stimulation did not induce atrial flutter or AF. LAAC was then completed as planned. Electrocardiogram (ECG) showed sinus rhythm, and echocardiography demonstrated improved cardiac remodeling at 3-month follow-up. Conclusions: AVRT is a type of supraventricular tachycardia caused by the presence of an accessory pathway due to congenital structural abnormalities. Our case reports an AVRT occurrence during PFA for AF and provides significant evidence that PFA is effective and safe for accessory pathway ablation during AF ablation.
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Qiu et al. (2026) conducted a case report in Persistent atrial fibrillation and atrioventricular reentrant tachycardia (n=1). Pulsed field ablation (PFA) and left atrial appendage closure (LAAC) under tubeless general anesthesia was evaluated on Restoration of sinus rhythm without induction of atrial flutter or fibrillation. Pulsed field ablation safely and effectively eliminated both persistent atrial fibrillation and an unexpected atrioventricular reentrant tachycardia, resulting in sinus rhythm and reverse cardiac remodeling at 3 months.
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