Figure Legends
Figure 1. CRC EP PFA catheters and system. The ElePulse PFA catheter design consists of an 8-French, 16-electrode, bidirectional, spiral mapping/ablation catheter intended for single-shot ablation. The PFA catheters are available in two diameter sizes (25-mm and 30-mm) with radiopaque tips and inserted through an 8.5-Fr long introducer. The larger (30-mm) catheter has 4 distal mapping electrodes. The PFA system delivers microsecond-wide, QRS-gated, bipolar, biphasic, pulsed electric fields synchronized with the cardiac cycle which allows for ablation using individually-selected or all electrodes.
Figure 2. PFA from inside the inferior vena cava (IVC) toward the adjacent deviated esophagus. A, the esophagus was deviated toward the IVC using an esophageal retractor device (DV8; Manual Surgical Sciences) as bipolar PFA (1.8–2.5 kV) was performed within the IVC through a deflectable introducer at areas contacting the deviated esophagus. B, A 3D map depicts the location of the spiral PFA catheter within the IVC at the time of ablation. CS=coronary sinus; ESO=esophagus; SVC=superior vena cava.
Figure 3. Electrical isolation following PFA confirmed by 3D mapping and intracardiac electrograms. Shown, are post-PFA 3D voltage maps with corresponding surface (aVF) and intracardiac electrograms recorded using a high-density mapping catheter placed initially inside the right superior (A) and subsequently in the right inferior (B) and left (C) PVs demonstrating complete electrical isolation of all 3 PVs and a significant portion of the posterior wall. CS=coronary sinus recording channels (proximal, mid and distal); HD=high-density (Advisor HD Grid, Abbott) mapping catheter recording channels; LAA=left atrial appendage; LPV=left PV; RIPV=right inferior PV; RSPV=right superior PV.
Figure 4. Pre- and post-PFA voltage maps. 3D LA map created pre- (A) and post-PFA (B) demonstrating the locations of PFA applications as illustrated by the spiral catheter contours on the 3D maps. C, Surface and intracardiac electrograms recorded during QRS-gated PFA using the spiral ablation catheter. Also shown, are 3D LA maps created at baseline (D) and at 1 day (E)and 21 days (F) post-PFA. As seen, there is complete and durable isolation of all 3 PVs and also a segment of the posterior wall.