Using a Novel Pulsed Field Ablation Technique to Identify the Critical Isthmus Within a Tachycardia Circuit

Pulsed field ablation uses irreversible electroporation to interrupt cellular membranes and induce myocyte apoptosis. Reversible electroporation has been used in other specialties, but its utility in cardiac ablation is unknown. Here, a 69-year-old woman undergoing repeat ablation for atypical atrial flutter presented with extensive scar after cardiac surgery (including MAZE) and previous ablation, leading to a macro re-entry circuit. To minimize superfluous lesions and further arrhythmia, we used a single pulse confirming the isthmus location, with cessation of the arrhythmia. As a conclusion, reversible electroporation may be used to test areas of interest prior to irreversible lesion creation.