# Termination of Longstanding Persistent Atrial Fibrillation Using a Novel Large Focal Lattice-Tip Pulsed Field Ablation Catheter: A Case Report

## TL;DR

A new catheter using pulsed field ablation helped terminate long-term atrial fibrillation in a complex case, showing promise for safer and more effective treatment.

## Contribution

Demonstrates the effectiveness of a novel large focal lattice-tip PFA catheter in terminating longstanding persistent AF.

## Key findings

- PFA delivery during posterior wall isolation terminated AF to normal sinus rhythm.
- Comprehensive lesion sets and advanced mapping technologies improved rhythm control in complex AF.
- Combined PFA and radiofrequency approach was safely used in a patient with large left atrium and prior nodal dysfunction.

## Abstract

Catheter ablation in longstanding persistent atrial fibrillation (AF) presents unique challenges, particularly in patients with large left atria and prior atrioventricular nodal dysfunction. While novel pulsed-field ablation (PFA) has been shown to be safer, no data yet show that a large focal lattice-tip catheter may be more effective. We present a 66-year-old man with symptomatic, longstanding, persistent AF and underlying sick sinus syndrome who underwent catheter ablation using Affera 3D mapping (Medtronic, Minneapolis, MN) and the Sphere 9 catheter (Medtronic, Inc, Mounds View, MN) to provide a combined pulsed field and radiofrequency approach. High-resolution electroanatomic mapping guided pulmonary vein isolation, which was extended to include posterior wall isolation, mitral isthmus ablation, and cavotricuspid isthmus ablation due to multiple arrhythmia foci. During delivery of PFA to complete posterior wall isolation, there was termination of AF to a normal sinus rhythm. This case highlights the utility of comprehensive lesion sets and advanced mapping technologies in achieving rhythm control in complex persistent AF.