Near‐Zero Fluoroscopy Ablation Workflow With a Circular Multielectrode Pulsed‐Field Ablation Catheter

ABSTRACT Background Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) is effective for treating atrial fibrillation (AF) but often requires fluoroscopy, posing risks of radiation exposure. Using a circular multi‐electrode PulseSelect catheter along with 3D electroanatomical mapping (3D‐EAM) and intracardiac echocardiography (ICE) enables pulmonary vein isolation (PVI) with near‐zero fluoroscopy. Methods All procedures were managed under general anesthesia. Following transseptal puncture, pre‐mapping was conducted using a multi‐electrode catheter. Based on these initial mappings, the PulseSelect catheter and guiding wire were visualized on the 3D‐EAM to perform PVI. After the procedure, post‐mapping was carried out to confirm that there was no electrical reconnection in the treated areas. Results The median times for isolation of the left and right pulmonary veins were 9.0 and 11.0 min, respectively. Total procedure time averaged 48.5 min, with fluoroscopy time limited to 0.1 min for initial registration. Pre‐ and post‐mapping indicated minimal deviations in catheter positioning, demonstrating controlled ablation without significant procedural complications. Holter monitoring at three months showed a low recurrence rate of atrial arrhythmias. Conclusion The near‐zero fluoroscopy PFA workflow using the PulseSelect catheter, combined with 3D‐EAM and ICE, significantly reduces radiation exposure, enhances procedural safety, and maintains efficacy in AF ablation. This approach confirms the feasibility of reducing reliance on fluoroscopy while ensuring accurate and safe ablation outcomes.