Pulsed-Field Ablation for Atrial Premature Complexes From the Right Atrial Appendage Apex: A Novel Application

TL;DR

This paper reports the first successful use of pulsed-field ablation to treat heart rhythm issues originating from a delicate part of the heart.

Contribution

The novel application of pulsed-field ablation for atrial premature complexes from the right atrial appendage apex is demonstrated for the first time.

Findings

Pulsed-field ablation successfully eliminated refractory atrial premature complexes after radiofrequency ablation failed.

PFA offers a safer alternative to thermal ablation in thin-walled cardiac structures.

This is the first reported case of PFA used for focal atrial premature complexes.

Abstract

Atrial premature complexes (APCs) refractory to medical therapy pose management challenges. Pulsed-field ablation (PFA) is established for atrial fibrillation but is unreported for focal APCs.

A 67-year-old woman with hypertension and hypothyroidism presented with 6-year refractory APCs (35.7% burden). Initial radiofrequency ablation at the right atrial appendage (RAA) apex failed owing to safety concerns. Subsequent PFA eliminated the APCs after 8 applications.

This first report demonstrates the efficacy of PFA for APCs originating from the RAA apex, avoiding the risks of thermal ablation in thin-walled structures.

PFA safely eliminates arrhythmias originating from the thin-walled RAA apex. This novel approach avoids thermal ablation risks in high-risk anatomical sites.

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