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. 2024 Oct 21;40(6):1529-1532.
doi: 10.1002/joa3.13174. eCollection 2024 Dec.

Workflow of the zero-fluoro pulsed field ablation

Shu Hirata  1 , Koichi Nagashima  1 , Ryuta Watanabe  1 , Yuji Wakamatsu  1 , Moyuru Hirata  1 , Sayaka Kurokawa  1 , Naoto Otsuka  1 , Masanaru Sawada  1 , Yasuo Okumura  1
Affiliations

Workflow of the zero-fluoro pulsed field ablation

Shu Hirata et al. J Arrhythm. .

Abstract

Background: Zero-fluoroscopic pulsed field ablation (PFA) is the next step in advancing pulmonary vein isolation (PVI) for atrial fibrillation (AF).

Methods: A workflow incorporating a variable-loop circular PFA catheter, intracardiac echocardiography (ICE), and a visualized sheath was applied to 15 paroxysmal AF patients.

Results: It consisted of three steps: (1) positioning a non-magnetic mapping catheter in the coronary sinus after creating a right atrial matrix, (2) transseptal puncture with the sheath advancement to the left atrium under ICE guidance, and (3) PFA confirming catheter-tissue contact with tissue proximity indication.

Conclusions: This zero-fluoro PFA workflow is feasible without advanced technique.

Keywords: atrial fibrillation; catheter ablation; pulmonary vein; pulsed field ablation.

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Conflict of interest statement

Authors declare no conflict of interests for this article.

Figures

FIGURE 1
FIGURE 1
(A) Placement of the mapping catheter without a magnetic sensor. (B) Reconstruction of the geometry of the pulmonary veins (PVs), left atrium (LA) and fossa ovalis (FO). (C) Transseptal puncture with a the VIZIGO sheath under intracardiac echocardiography (ICE) guidance. (D) Advancement of the VIZIGO sheath into the LA. (E) Positioning the VARIPULSE catheter in the LA. CS, coronary sinus; CT, computed tomography; FO, fossa ovalis; ICE, intracardiac echocardiography; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RF, radiofrequency; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; SVC, superior vena cava.
FIGURE 2
FIGURE 2
Pulsed field ablation with the VARIPULSE catheter for (A) right superior pulmonary vein (RSPV), (B) right inferior pulmonary vein (RIPV), (C) left superior pulmonary vein (LSPV), and (D) left inferior pulmonary vein (LIPV). An electrode with both sides lit up indicates a TPI positive. The dark purple tag indicates the sites where all three applications of pulse field energy were completed in each position. The light purple tag indicates the sites where only one or two applications were completed. The TPI filter is not used. LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PVI, pulmonary vein isolation; RF, radiofrequency; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; TPI, tissue proximity indication.
See this image and copyright information in PMC

References

    1. Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, et al. Safety and effectiveness of pulsed field ablation to treat atrial fibrillation: one‐year outcomes from the MANIFEST‐PF registry. Circulation. 2023;148:35–46. 10.1161/CIRCULATIONAHA.123.064959 - DOI - PubMed
    1. Duytschaever M, De Potter T, Grimaldi M, Anic A, Vijgen J, Neuzil P, et al. Paroxysmal atrial fibrillation ablation using a novel variable‐loop biphasic pulsed field ablation catheter integrated with a 3‐dimensional mapping system: 1‐year outcomes of the multicenter inspIRE study. Circ Arrhythm Electrophysiol. 2023;16:e011780. 10.1161/CIRCEP.122.011780 - DOI - PMC - PubMed
    1. Rehani MM, Ortiz‐Lopez P. Radiation effects in fluoroscopically guided cardiac interventions—keeping them under control. Int J Cardiol. 2006;109:147–151. 10.1016/j.ijcard.2005.06.015 - DOI - PubMed
    1. Reddy VY, Morales G, Ahmed H, Neuzil P, Dukkipati S, Kim S, et al. Catheter ablation of atrial fibrillation without the use of fluoroscopy. Heart Rhythm. 2010;7:1644–1653. 10.1016/j.hrthm.2010.07.011 - DOI - PubMed
    1. Huo Y, Christoph M, Forkmann M, Pohl M, Mayer J, Salmas J, et al. Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3‐dimensional electroanatomic mapping system: a prospective, randomized, single‐blind, and controlled study. Heart Rhythm. 2015;12:1945–1955. 10.1016/j.hrthm.2015.05.018 - DOI - PubMed

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