Alessandro Parlato, Moneeb Khalaph, Philipp Sommer, Christian Sohns
{"title":"左心房底物修饰和肺静脉隔离使用一种新型圆形可变回路脉冲场消融导管。","authors":"Alessandro Parlato, Moneeb Khalaph, Philipp Sommer, Christian Sohns","doi":"10.1093/ehjcr/ytaf209","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is a recently developed technology that causes tissue necrosis through electroporation and has been employed and validated for pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation. Only few devices have received a CE mark for this use and the Varipulse<sup>TM</sup> catheter (Varipulse<sup>TM</sup>, Biosense Webster, Irvine, USA), a variable loop PFA catheter, has been recently approved. Despite the growing experience with PVI, evidence is lacking about the use of PFA catheters and linear ablation lesions, which could potentially be performed with PFA catheters, reducing procedure related costs and time.</p><p><strong>Case summary: </strong>A 73-year-old Caucasian woman with multiple cardiovascular risk factors presented with highly symptomatic paroxysmal AF and was scheduled to undergo PFA AF ablation using the new Varipulse catheter. The procedure was performed under deep sedation and the catheters were advanced through trans-septal puncture. 3D electroanatomic mapping of the left atrium showed significant anterior wall fibrosis. After PVI, substrate modification through an anterior mitral line (AML) approach was pursued. The AML was performed with additional PFA applications and successful bidirectional block was confirmed by pacing maneuvers without any procedural complications. The patient was discharged the following day, asymptomatic and in a state of well-being.</p><p><strong>Conclusion: </strong>Individual LA substrate modification, including linear lesion sets, can be delivered in addition to PVI using the novel Varipulse PFA catheter in patients with AF.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf209"},"PeriodicalIF":0.8000,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093309/pdf/","citationCount":"0","resultStr":"{\"title\":\"Left atrial substrate modification in addition to pulmonary vein isolation using a novel circular variable loop pulsed field ablation catheter.\",\"authors\":\"Alessandro Parlato, Moneeb Khalaph, Philipp Sommer, Christian Sohns\",\"doi\":\"10.1093/ehjcr/ytaf209\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pulsed field ablation (PFA) is a recently developed technology that causes tissue necrosis through electroporation and has been employed and validated for pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation. Only few devices have received a CE mark for this use and the Varipulse<sup>TM</sup> catheter (Varipulse<sup>TM</sup>, Biosense Webster, Irvine, USA), a variable loop PFA catheter, has been recently approved. Despite the growing experience with PVI, evidence is lacking about the use of PFA catheters and linear ablation lesions, which could potentially be performed with PFA catheters, reducing procedure related costs and time.</p><p><strong>Case summary: </strong>A 73-year-old Caucasian woman with multiple cardiovascular risk factors presented with highly symptomatic paroxysmal AF and was scheduled to undergo PFA AF ablation using the new Varipulse catheter. The procedure was performed under deep sedation and the catheters were advanced through trans-septal puncture. 3D electroanatomic mapping of the left atrium showed significant anterior wall fibrosis. After PVI, substrate modification through an anterior mitral line (AML) approach was pursued. The AML was performed with additional PFA applications and successful bidirectional block was confirmed by pacing maneuvers without any procedural complications. The patient was discharged the following day, asymptomatic and in a state of well-being.</p><p><strong>Conclusion: </strong>Individual LA substrate modification, including linear lesion sets, can be delivered in addition to PVI using the novel Varipulse PFA catheter in patients with AF.</p>\",\"PeriodicalId\":11910,\"journal\":{\"name\":\"European Heart Journal: Case Reports\",\"volume\":\"9 5\",\"pages\":\"ytaf209\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2025-05-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093309/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Heart Journal: Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjcr/ytaf209\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal: Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjcr/ytaf209","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Left atrial substrate modification in addition to pulmonary vein isolation using a novel circular variable loop pulsed field ablation catheter.
Background: Pulsed field ablation (PFA) is a recently developed technology that causes tissue necrosis through electroporation and has been employed and validated for pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation. Only few devices have received a CE mark for this use and the VaripulseTM catheter (VaripulseTM, Biosense Webster, Irvine, USA), a variable loop PFA catheter, has been recently approved. Despite the growing experience with PVI, evidence is lacking about the use of PFA catheters and linear ablation lesions, which could potentially be performed with PFA catheters, reducing procedure related costs and time.
Case summary: A 73-year-old Caucasian woman with multiple cardiovascular risk factors presented with highly symptomatic paroxysmal AF and was scheduled to undergo PFA AF ablation using the new Varipulse catheter. The procedure was performed under deep sedation and the catheters were advanced through trans-septal puncture. 3D electroanatomic mapping of the left atrium showed significant anterior wall fibrosis. After PVI, substrate modification through an anterior mitral line (AML) approach was pursued. The AML was performed with additional PFA applications and successful bidirectional block was confirmed by pacing maneuvers without any procedural complications. The patient was discharged the following day, asymptomatic and in a state of well-being.
Conclusion: Individual LA substrate modification, including linear lesion sets, can be delivered in addition to PVI using the novel Varipulse PFA catheter in patients with AF.