Nanosecond Pulsed Field Ablation for Atrial Fibrillation in a Patient with Cor Triatriatum Dexter and Atrial Septal...

Pulsed field ablation (PFA) is an emerging non-thermal energy modality that enables selective injury to cardiomyocytes while minimizing collateral damage to adjacent structures. In this case, we present the application of PFA in a symptomatic, drug-refractory paroxysmal atrial fibrillation (AF) patient complicated by incomplete cor triatriatum dexter (CTD) and atrial septal defect (ASD).

A 54-year-old female was referred to the institution for palpitations, dyspnea, and dizziness persisting for more than 5 years after she was first diagnosed with paroxysmal AF. Computed tomography revealed that an enlarged right atrium was incompletely divided into two chambers by an abnormal membrane and an obvious defect in the middle of the atrial septum. The circular PFA catheter connected to the CardiPulse PFA System was advanced into the left atrium through the defective atrial septum without transseptal puncture. The ablation of pulmonary veins (PV) and superior vena cava (SVC) was performed using nanosecond PFA. The PV and SVC isolation was successfully achieved without any complications. Her symptoms improved after the ablation procedure, and no AF recurrence occurred during the 6-month follow-up.

This case demonstrated the feasibility and safety of PFA as an ablation strategy for the AF patient with incomplete CTD and ASD.