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.