Pulsed Field Ablation: Maze? Mapping? Mania?-Pulsed Field Ablation: Maze? Mapping? Mania?

Video Transcription

Video Summary

The session at Heart Rhythm 2025 in San Diego focused on advancements in pulse field ablation (PFA) for atrial fibrillation (AFib), particularly the debate over whether mapping is required during procedures. Dr. Julian Chun argued mapping is not always necessary for PFA AFib ablation, citing procedural efficiency without compromising outcomes. In contrast, Dr. Andrea Sarkozy contended that mapping and 3D electron anatomical mapping could improve procedural outcomes, especially in inexperienced operators or complex cases.<br /><br />Next, Dr. Atul Verma discussed the benefits of adding posterior wall isolation to PVI, particularly with PFA, suggesting potential improved outcomes without significant esophageal risk. However, data on its effectiveness remains inconclusive without large trials. Dr. Ilad Anter advocated reconsidering the catheter-based MACE procedure with PFA for more complex or persistent AFib cases, emphasizing the potential for comprehensive lesions and addressing both atrial triggers and drivers, but recognized the need for randomized trials to confirm efficacy and safety.<br /><br />The session was interactive, with discussions on technical complexities, risks related to overablation, and the need for a standardized approach in specific patient scenarios, reflecting both optimism and caution towards expanding ablation strategies.

Keywords

Heart Rhythm 2025

San Diego

pulse field ablation

atrial fibrillation

mapping debate

posterior wall isolation

PVI

MACE procedure

ablation strategies