# Retracting PetAls againST the sEptum (Re-PASTE) technique for right inferior pulmonary vein pentaspline pulsed field ablation: A case report

## TL;DR

A new technique called Re-PASTE improves the success of pulsed field ablation for a challenging heart procedure in patients with atrial fibrillation.

## Contribution

The Re-PASTE technique is introduced to address anatomical challenges in right inferior pulmonary vein ablation using pulsed field ablation.

## Key findings

- The Re-PASTE technique enabled successful access to the right inferior pulmonary vein using fluoroscopic guidance alone.
- The technique utilizes catheter and sheath design features to ensure stable positioning and clear identification of anatomical boundaries.
- Re-PASTE is simple, reproducible, and effective for overcoming technical limitations in pulsed field ablation procedures.

## Abstract

Pulsed field ablation is a nonthermal ablation modality with favorable safety and efficacy profiles for pulmonary vein isolation in patients with atrial fibrillation. However, isolating the right inferior pulmonary vein can be technically challenging because of anatomical limitations and restricted catheter maneuverability. We report the case of a 47-year-old man with symptomatic, drug-refractory paroxysmal atrial fibrillation who underwent successful pulsed field ablation under general anesthesia using the FARAPULSE system. The Retracting the PetAls (in the flower configuration) againST the sEptum (Re-PASTE) technique was used in combination with radiopaque markers on the pentaspline FARAWAVE catheter and FARADRIVE sheath to facilitate accurate right inferior pulmonary vein access using fluoroscopic guidance alone. The Re-PASTE technique benefits from the design features of the pentaspline PFA catheter and sheath, such as their widths and lengths and their radiopaque markers, thereby enabling clear identification of the right–left atrial boundary and stable catheter positioning without spline deformation. The technique is simple, reproducible, and effective in addressing right inferior pulmonary vein anatomical challenges. The Re-PASTE technique may enhance procedural safety and efficiency, particularly in cases with difficult right inferior pulmonary vein anatomy, offering a practical solution to a common technical limitation in pulsed field ablation procedures.