Focal Point-by-point Pulsed Field Ablation for the Treatment of Atrial Arrhythmias in Patients with Challenging Anatomy Where Radiofrequency Ablation Cannot Be Applied: A Case Series

Catheter ablation is the cornerstone treatment of atrial arrhythmias by restoring sinus rhythm, reducing symptoms, and improving quality of life.1,2 Thermal energy sources, including radiofrequency energy and cryoenergy, have been well studied and demonstrated to be effective.3 However, they are associated with a risk of damage of the adjacent organs and anatomical structures owing to thermal conduction. Secondary damage to the phrenic nerve, esophagus (including a hiatal hernia), and surrounding vessels is of particular concern owing to proximity to the heart.