Case Report: Pulsed field ablation for epicardial right-sided accessory pathway

Area of Science:

• Electrophysiology
• Cardiovascular Medicine

Background:

• Accessory pathways can cause preexcitation and palpitations, necessitating catheter ablation.
• Epicardial accessory pathways present unique challenges for ablation due to their location.
• Recurrent or refractory cases require exploration of alternative ablation modalities.

Observation:

• A 32-year-old male with a history of palpitations and preexcitation underwent four failed catheter ablations for a right free wall accessory pathway.
• Electrophysiological studies suggested an epicardial accessory pathway, which resisted radiofrequency ablation.
• The Farawave catheter utilizing pulsed field ablation in a flower configuration achieved successful pathway interruption.

Findings:

• Pulsed field ablation with the Farawave catheter effectively terminated accessory pathway conduction in a patient with multiple prior failed ablations.
• Intracardiac echocardiography confirmed good contact during radiofrequency energy delivery, highlighting the pathway's resistance.
• Long-term follow-up confirmed the persistent success of pulsed field ablation.

Implications:

• Pulsed field energy presents a promising alternative for ablating challenging epicardial accessory pathways.
• This technique may obviate the need for invasive epicardial mapping and access, potentially enhancing procedural safety.
• Successful pulsed field ablation could improve outcomes for patients with refractory accessory pathway conduction.