When catheter ablation is performed for atrial fibrillation (AF), atrial flutter and complex atrial substrate can require ablation beyond pulmonary vein isolation. In Journal of Clinical Medicine, a retrospective analysis reported acute outcomes and complications for pulsed field ablation (PFA) used for pulmonary vein isolation (PVI) and for mapping and ablation of non-pulmonary vein targets in patients with AF.

The analysis included 60 patients with paroxysmal AF or persistent AF who underwent catheter ablation. The mean age was 67.15 ± 9.01 years, and 25 patients (41.6%) were female. Persistent AF was present in 34 patients (60%), and six patients (10%) had atrial flutter as the initial rhythm during the index procedure. PVI was performed in all patients using PFA as per protocol. Non-pulmonary vein ablation was performed in 46 patients (76.7%), including posterior wall isolation in 25 patients (41.7%), roof line ablation in nine patients (15%), anterior line ablation in 16 patients (26.7%), cavotricuspid isthmus ablation in 11 patients (18.3%), and superior vena cava isolation in two patients (3.3%). Overall, 27 patients had atrial flutters during the index procedure that were mapped and ablated, with termination achieved in all but one patient.

For electrophysiology practice, the report describes feasibility of using PFA for mapping and ablation of atypical atrial flutter and non-pulmonary vein targets during AF ablation in a cohort with complex atrial substrate and arrhythmias. Major complications were not detected.

The series reports that PFA was feasible for PVI and for ablation of non-pulmonary vein targets and atrial flutter during the index procedure in patients with AF.