Pulsed-Field Ablation of Confluent Inferior Pulmonary Vein With Narrowing and a Low-Voltage Area: A Case Report

Confluent inferior pulmonary vein (CIPV) often has narrow ostia and low-voltage areas in the common trunk. We treated a man in his 60s with atrial fibrillation. Cardiac computed tomography revealed a CIPV with a 5 mm narrow left inferior pulmonary vein (PV) ostium. Electroanatomical mapping showed low-voltage areas in the common trunk. Using guidewire-assisted PulseSelect™ pulsed-field ablation (PFA), we performed PV isolation and left atrial posterior wall isolation. CIPV often manifests as narrow left inferior PV ostia, thin posterior walls, and low-voltage or scar areas in the common trunk. PFA, particularly with the PulseSelect™ system, is well-suited to minimizing PV stenosis and the risk of esophageal injury.