case_images: PMC10801091_01
case_images: A: Cardiac computed tomography (CT) angiogram showing proximity between the saccular anterior aortic aneurysm and the left inferior pulmonary vein. B, C: Three-dimensional anatomical reconstruction integrating chest CT and 3-dimensional electroanatomical map (CARTO; Biosense Webster) demonstrating the proximity of the aneurysm to the applications of focal point-by-point pulsed field ablation (light blue balls) on the posterior wall of the left pulmonary veins (LPVs); right lateral (B) and posterior (C) views. LA = left atrium; RPVs = right pulmonary veins.
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case_images: fig1
case_images: Routine preprocedural work-up included a cardiac computed tomography angiogram, which demonstrated a saccular aneurysm of the anterior portion of the descending aorta, intimately involved with the posterior wall of the left atrium (LA) and the posteroinferior part of the left inferior PV, with significant narrowing of its ostium (Figure 1A). Anatomical reconstruction demonstrated a significant application of PFA energy opposite to the aortic aneurysm (Figure 1B-1D).
case_images: PMC10801091_02
case_images: A: Cardiac computed tomography (CT) angiogram showing proximity between the herniated stomach and the left atrium (LA). B-D: Three-dimensional anatomical reconstruction integrating chest CT and 3-dimensional electroanatomical map (CARTO; Biosense Webster) demonstrating the proximity of the herniated stomach (shadowed dark blue) to the applications of focal point-by-point pulsed field ablation (light blue balls) on the posterior wall: B, posterior; C, left lateral; D, right lateral views. LPVs = left pulmonary veins; RPVs = right pulmonary veins.
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case_images: Preprocedural cardiac computed tomography angiogram revealed a hiatal hernia with herniation of part of the stomach into the thoracic cavity (Figure 2A).
case_images: PMC10801091_03
case_images: Three-dimensional electroanatomical map (CARTO; Biosense Webster) showing the proximity of focal point-by-point pulsed field ablation applications (light blue points) and phrenic nerve path (gray shadowed structure along the right atrium map) in sinus rhythm (A) and during atrial tachycardia (B).
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case_images: fig3
case_images: We then mapped the path of the phrenic nerve using high-output stimulation with the ablation catheter (ThermoCool SmartTouch Catheter; Biosense Webster) on the lateral wall of the right atrium (Figure 3).