Safe and simple pulsed field ablation application using integrated 3D system for AF patients with cardiac tumors.

Abstract

Background: Reports on catheter ablation for atrial fibrillation (AF) in patients with intracardiac tumors are scarce.

Case summary: We report a case of persistent AF in which the procedure was completed simply, and safely, using the FARAVIEW system, which is a 3D-integrated pulsed field ablation (PFA) system incorporating the FARAPULSE PFA system, alongside intracardiac echocardiography (ICE). The simplicity was evident in the relatively short procedure time, despite careful navigation around the cardiac tumor using FARAVIEW and ICE. Safety was paramount; we successfully performed pulmonary vein isolation, posterior wall isolation, and post-ablation mapping without causing symptomatic cerebral embolism. The FIELDTAG feature on the 3D-CT fusion image allowed for precise prediction of the isolation area and visualization of the tumor's location. This integrated approach led to the efficient termination of AF and subsequent improvement in heart failure status.

Conclusions: This case demonstrates that the combination of ICE, and the 3D-integrated PFA system ensures safe left atrial ablation in the presence of a cardiac mass. Specifically, FIELDTAG on 3D-CT provided crucial visualization of the spatial relationship between the tumor and ablation lesions, enhancing procedural safety.