Left atrial anterior wall linear ablation with a circular pulsed field catheter for mitral annular flutter after radiofrequency ablation failure

The circular PFA catheter PulseSelect can be effective for linear left atrial anterior wall ablation in case of mitral annular flutter refractory to radiofrequency ablation treatment.In this case, PFA was faster and more effective than radiofrequency, achieving a clear line of bidirectional block without damage to adjacent atrial tissue and without signs of vasospasm.Non-fluoroscopic navigation systems and fluoroscopy can be used to secure proper orientation of the fifth electrode toward the anterior wall and adequate use of the deflectable sheath must be employed to position the catheter linearly in a superoinferior direction.