LAUSR

A 69-year-old male patient with a pacemaker, previous hypertension, myocardial infarction, and long-standing persistent atrial fibrillation (AF) was referred for staged convergent hybrid ablation AF ablation. During this procedure, epicardial surgical ablation of the left atrial (LA) posterior wall (PW) is performed followed by endocardial catheter ablation of the pulmonary veins (PV) and remaining PW gaps [1]. We present a case of staged convergent hybrid ablation where pulsed field ablation (PFA) was used for the endocardial procedure. Nine weeks after the epicardial procedure, 3D-electroanatomic mapping of the LA (ENSITE Precision) showed a large PW lesion (Fig. 1 Panel A). Additional PV isolation was performed with a 35-mm PFA catheter (FARAPULSE, Fig. 1 Panel B) with four applications in the flower and four in the basket shape for each PV. The posterior box was extended superiorly to the PW area inaccessible during surgical ablation due to pericardial reflections, with the PFA catheter in the flower position (positions are shown in Panel B). Remapping confirmed PV isolation and posterior box extension. No esophageal temperature probe was used. Total procedure time was 76 min. We present the first case of convergent hybrid convergent AF ablation where PFA technology was used for endocardial ablation. PFA is a novel ablation modality with high acute efficacy, fast ablation times, and tissue selectivity, which is especially important when ablating the PW thus sparing the esophagus [2]. Here, PFA seems to offer a good alternative to radiofrequency technology.