Pulsed Field Ablation in Atrial Fibrillation: First Reported Mexican Experience and Procedural Learning Curve

Pulsed field ablation (PFA) is a novel non-thermal modality for atrial fibrillation (AF) ablation that selectively targets myocardial tissue while minimizing collateral injury. While widely reported in Europe and the United States, data from Latin America remain scarce.

We present the first four cases of PFA performed in Monterrey, Mexico. All procedures were conducted with ultrasound-guided femoral venous access, transseptal puncture using FastCath SL1 and Brockenbrough needle guided with intracardiac echocardiography, mapping with pentaray catheter, and ablation with a PulsedSelect PFA catheter via a FlexCath sheath. Antral pulmonary vein isolation was the primary endpoint, with posterior wall ablation performed at operator discretion.

Pulmonary vein isolation was achieved in all patients. Two patients underwent posterior wall ablation. Isthmus measurements were obtained only in patients who underwent pulmonary vein isolation alone, with posterior isthmus lengths of 16.9 mm and 12 mm. Three patients maintained sinus rhythm throughout the procedure; one patient with a common right pulmonary vein trunk and an enlarged left atrial volume index (LAVI) developed intraprocedural AF requiring electrical cardioversion. Mean procedure time was 149 min (range 105-220), and mean fluoroscopy time was 22 min (range 14-27). No complications occurred.

This first Mexican experience demonstrates that PFA is feasible and safe, with reproducible pulmonary vein isolation and a short procedural learning curve. These findings align with international reports and support the integration of PFA into AF ablation strategies in Latin America.