Ablation in Adult Congenital Heart Disease Using a Dual-Energy, Lattice-Tip, Large-Footprint, Map-and-Ablate Catheter.

Background Patients with adult congenital heart disease (ACHD) often develop atrial and ventricular arrhythmias. Ablation is challenging given complex anatomy and previous surgical repair. Pulsed-field ablation (PFA) offers improved efficacy and safety through myocardial selectivity. Novel catheters combining three-dimensional electroanatomical mapping with both PFA and radiofrequency ablation (RFA) streamline procedures in ACHD patients.Methods We present a case series of 5 ACHD patients with symptomatic atrial and/or ventricular arrhythmias who underwent ablation using a dual-energy "map-and-ablate" lattice-tip catheter.Results Using the lattice-tip catheter, pulmonary vein isolation, cavotricuspid isthmus ablation, and ablation of scar-related intra-atrial re-entry with combined RFA and PFA were performed in 2 patients and ablation of re-entrant ventricular arrhythmias in 3 patients. In 2 patients, both atrial and ventricular arrhythmias were ablated in the same procedure.Conclusions Use of a large-area focal ablation catheter with mapping integration and dual-energy capabilities enables efficient and safe atrial and ventricular arrhythmia ablation in patients with ACHD.