# Safety of extensive pulsed field ablation for atrial fibrillation in a patient with left ventricular assist device: a case report

## TL;DR

This case report shows that pulsed field ablation can safely treat atrial fibrillation in a patient with a heart pump.

## Contribution

First reported use of pulsed field ablation for AF and atrial flutter in a continuous-flow LVAD patient.

## Key findings

- PFA successfully restored sinus rhythm without LVAD interference.
- No complications occurred during transseptal approach or ablation.
- Patient remained in sinus rhythm with no arrhythmia recurrence at 8 months.

## Abstract

Pulsed field ablation (PFA) is increasingly adopted for catheter atrial fibrillation (AF) ablation due to its safety and efficacy as compared to thermal energies. Left ventricular assist device (LVAD) is also an established treatment in patients with advanced heart failure. Radiofrequency catheter ablation of AF in LVAD carriers has only been case-reported. Pulsed field energy using a pentaspline catheter has never been reported for combined AF and typical atrial flutter in a continuous-flow LVAD patient.

We report the case of a 57-year-old male with advanced heart failure due to a non-ischaemic dilated cardiomyopathy. A LVAD was successfully implanted. Despite amiodarone and beta-blockers, the patient experienced symptomatic recurrent AF and atrial flutter with multiple episodes per day of low flow alarm by the LVAD. The patient was scheduled for catheter ablation and pulsed field energy was selected to shorten the time of the general anaesthesia. Under fluoroscopy guidance pulmonary vein isolation (PVI), posterior wall isolation (PWI) and cavotricuspid isthmus (CTI) ablation were successfully performed, leading to sinus rhythm restoration and symptom relief without any interference with the LVAD. At 8 months of follow-up, the patient was in sinus rhythm and did not experience any heart failure decompensation or atrial arrhythmia recurrence.

This case highlights the feasibility and the safety of PFA-assisted PVI, PWI, and CTI ablation in LVAD patients. No complications related to the transseptal approach or interference of pulsed field energy with the LVAD have been detected.