case_images: PMC10751562_01
case_images: (A) The electrocardiogram of atrial flutter before operation. (B) The image of linear pulse-field ablation catheter with red circles marking different parts of the catheter. (C) Damage caused by the linear catheter ablation on the cavo-tricuspid isthmus of pigs. The yellow dotted line represented the damaged area. (D) Haematoxylin and eosin staining of the damaged area showed no myocardial fibres (bar = 100 microm). (E and F) The X-ray images when arrhythmia was terminated and bidirectional block was achieved. CS, coronary sinus; ICE, intracavitary ultrasound; ABL, ablation catheter.
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case_images: The electrocardiogram (ECG) reveals atrial flutter (Figure 1A) in a 71-year-old patient with a history of coronary artery bypass surgery. The scheduled procedure involves pulsed-field ablation using a linear ablation catheter (PulseLine, PL03F07N, EnChannel Medical Guangzhou Inc) and a pulsed electric field instrument (NanoAblate, PG-01, EnChannel Medical Guangzhou Inc), which has been shown to cause sustained damage in animal studies (Figure 1B-F).
case_images: (A) Red, orange, yellow, green, cyan, blue, and violet represented the sequence of tachycardia in the isochronous diagram of the left and right anterior oblique, which indicated the electroanatomical mapping with tricuspid annular reverse clock return. (B and C) The ablation of linear pulse-field ablation terminated the tachycardia. (D and E) The catheter was placed on the other side of the block line, and the pacing time from CS90 to ABL12 was 150 ms, while the pacing time from ABL12 to CS90 was 156 ms. (F) The electrocardiogram 2 months after ablation indicated sinus rhythm.
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case_images: PMC10751562_01_ytad601f2.jpg
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case_images: The electroanatomical mapping of the tachycardia as well as entrainment manoeuvres indicates typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (Figure 2A). After beginning the continuous infusion with nitroglycerine (5 mug/min), one linear pulsed-field ablation at the tricuspid isthmus terminates the atrial flutter (Figure 2B and C). Subsequently, atrial activation during septal and lateral atrial pacing confirms the bidirectional CTI block (Figure 2D and E). Over the following 2 months, the patient remains free of arrhythmias (Figure 2F).