Pulsed Field Ablation in a Rheumatic Heart Disease Patient With Mechanical Mitral and Tricuspid Valves

Pulsed field ablation (PFA) is a novel nonthermal modality for atrial fibrillation (AF) in patients with mechanical valves. We report the first successful PFA in a 44-year-old woman with both mechanical mitral and tricuspid valve replacements and a prior surgical maze procedure. Intracardiac echocardiography (ICE) and fluoroscopy-guided catheter navigation, avoiding prosthetic structures. Anatomical and voltage mapping revealed reconnection of prior surgical lines. PFA achieved isolation of the posterior wall, right pulmonary veins, inter-caval line, and cavotricuspid isthmus without complications. This case demonstrates the feasibility and safety of PFA in complex structural heart disease with dual mechanical valves.