How to Use a Variable Loop Circular Catheter to Perform Zero Fluoro Pulmonary Vein Isolation With Pulsed Field Ablation

BACKGROUND: The variable loop circular catheter (VLCC) called VARIPULSE is a novel device designed for catheter ablation of atrial fibrillation (AFib) and electro-anatomical mapping via 3D intracardiac echocardiography (ICE). Described herein is a streamlined workflow for AFib ablation and reported feasibility, procedural efficiency, and early safety signals of the first 34 consecutive patients. The technical details of step-by-step techniques are described to serve as a practical guide for clinicians and investigators. METHODS: A retrospective, single-center review of procedural parameters was done on 34 paroxysmal and/or persistent AFib patients who were treated with a VLCC for both mapping and ablating between January 1, 2025 and May 15, 2025. The workflow of all procedures was comprised of general anesthesia administration, placement of 2 sheaths via ultrasound guided access, administration of a heparin bolus, 3D anatomical mapping of the pulmonary veins with CARTOSOUND FAM, a transeptal puncture, VLCC ablation, and then closure. Figures illustrating key procedural steps, including catheter maneuvering, are included. RESULTS: All 34 cases were done without fluoroscopy, with a median procedural time of 40.5 [IQR 19] min. After 10 procedures per operator, consistently shorter procedure times (<45min) were achieved. No major acute or 30-day complications were observed. CONCLUSION: This review of the initial 34 patients undergoing ICE and cardiac ablation using the VLCC catheter, exhibits a fluoroless, streamlined workflow that is feasible and operationally efficient, with early safety signals that require validation in larger, prospective studies. Notably, this approach did not require multiple transvenous access sites, pre-procedural cross-sectional imaging, right atrial matrix, or additional multielectrode catheters that would necessitate frequent catheter-cable switching.