First experience of zero-fluoro pulsed field ablation for atrial fibrillation: step-by-step. A case report

Introduction. Pulsed field ablation (PFA) is an innovative method for the treatment of atrial fibrillation (AF). The concept of zero-fluoroscopy during ablation procedures is not new. The feasibility and safety of intracardiac echocardiography (ICE)-guided radiofrequency pulmonary vein (PV) isolation have been previously described. In this case, we aim to demonstrate a method of non-fluoro PFA without the 3D navigation mapping system. Brief description . We present the first successful experience of pulmonary vein PFA using a domestic circular catheter under ICE guidance in a patient with paroxysmal AF. Transmurality in the ablation area was confirmed by subsequent 3D electroanatomical mapping. Discussion . We have identified the following key messages: (1) ICE-guided positioning of the circular catheter is feasible and safe; (2) imaging of tight catheter contact with the pulmonary vein ostia is a mandatory aspect of the PFA procedure and ensures isolation in the target area, as confirmed by electroanatomical mapping; (3) the high safety profile of the procedure, achieved through real-time imaging, may contribute to a reduction in the risk of intraoperative complications. Conclusion . ICE-guided zero-fluoro PFA represents a new step in the treatment of AF. However, further studies are needed to evaluate the safety of the zero-fluoro approach compared to conventional fluoroscopic imaging methods during PFA in patients with AF.