Key result
Focal pulsed field ablation at the mitral isthmus causes transient vein of Marshall electrogram suppression.
Case Report (n=1)
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Pulsed field ablation at the mitral isthmus can cause transient, reversible electrogram attenuation in the epicardial vein of Marshall, necessitating careful observation and potentially repetitive applications to ensure durable conduction block.
IMAGE: Reversible effect of pulsed field application on electrograms in the vein of Marshall (VOM). CASE SUMMARY: Focal pulsed field ablation at the mitral isthmus attenuated the VOM electrograms. However, the electrogram amplitudes recovered after 4.5 minutes, accompanied by reconduction across the mitral isthmus line. Additional applications eliminated the VOM electrograms, which did not recur thereafter. TAKE-HOME MESSAGES: Pulsed field ablation may be more likely than radiofrequency ablation to cause reversible attenuation of electrogram amplitude, even in epicardial tissue. Even when conduction block is achieved, it may be transient or incomplete; therefore, careful observation and, when necessary, repetitive applications are warranted.
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Sakamoto et al. (2026) reported a case report. Focal pulsed field ablation at the mitral isthmus was evaluated on Vein of Marshall electrogram elimination and mitral isthmus conduction block. Focal pulsed field ablation at the mitral isthmus caused transient attenuation of vein of Marshall electrograms that recovered after 4.5 minutes, requiring additional applications for elimination.
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