Workflow of the zero-fluoro pulsed field ablation.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Pulmonary vein isolation (PVI) is a key treatment for atrial fibrillation (AF).
• Zero-fluoroscopic pulsed field ablation (PFA) represents an advancement in PVI procedures.
• Minimizing radiation exposure during PVI is a significant clinical goal.

Purpose of the Study:

• To evaluate the feasibility of a novel zero-fluoroscopic PFA workflow for PVI in patients with paroxysmal AF.
• To assess the integration of intracardiac echocardiography (ICE) and visualized sheath technology in PFA procedures.
• To determine if this workflow can be performed without requiring advanced techniques.

Main Methods:

• A workflow utilizing a variable-loop circular PFA catheter, ICE, and a visualized sheath was implemented.
• The procedure involved 15 patients with paroxysmal atrial fibrillation.
• Key steps included catheter positioning, transseptal puncture under ICE guidance, and PFA with tissue contact confirmation.

Main Results:

• The described zero-fluoroscopic PFA workflow was successfully applied to 15 patients.
• Intracardiac echocardiography and visualized sheath facilitated accurate catheter and sheath navigation.
• Confirmation of catheter-tissue contact with proximity indication was achieved during PFA delivery.

Conclusions:

• The developed zero-fluoroscopic PFA workflow is feasible for pulmonary vein isolation in paroxysmal AF patients.
• The workflow does not necessitate highly specialized techniques, suggesting broader applicability.
• This approach offers a promising radiation-sparing alternative for AF treatment.