Workflow of the zero‐fluoro pulsed field ablation
Shu Hirata, Koichi Nagashima, Ryuta Watanabe, Yuji Wakamatsu, Moyuru Hirata, Sayaka Kurokawa, Naoto Otsuka, Masanaru Sawada, Yasuo Okumura
Abstract
Background: Zero-fluoroscopic pulsed field ablation (PFA) is the next step in advancing pulmonary vein isolation (PVI) for atrial fibrillation (AF). Methods: A workflow incorporating a variable-loop circular PFA catheter, intracardiac echocardiography (ICE), and a visualized sheath was applied to 15 paroxysmal AF patients. Results: It consisted of three steps: (1) positioning a non-magnetic mapping catheter in the coronary sinus after creating a right atrial matrix, (2) transseptal puncture with the sheath advancement to the left atrium under ICE guidance, and (3) PFA confirming catheter-tissue contact with tissue proximity indication. Conclusions: This zero-fluoro PFA workflow is feasible without advanced technique.