ICE‐Guided Cavotricuspid Isthmus Ablation Using a Circular Multielectrode Pulsed‐Field Catheter: Stepwise Strategy

Pulsed-field ablation (PFA) using a circular multielectrode catheter is a novel approach for cavotricuspid isthmus (CTI) ablation, but optimal procedural strategy is not well established. We report two cases where intracardiac echocardiography (ICE) guidance was essential for achieving durable conduction block. ICE enabled identification of suboptimal contact missed under fluoroscopy, guiding catheter repositioning, or configuration change to adapt to anatomical challenges, including a CTI pouch. This stepwise, ICE-guided approach improved lesion delivery, prevented conduction gaps, and may help avoid repeat procedures. This report highlights the value of ICE for optimizing CTI ablation with PFA.