Pulsed-field ablation for atrial fibrillation treatment during open heart surgery: a case report

Pulsed-field ablation is a new treatment option for atrial fibrillation. However, information regarding the use of this type of energy during open-heart surgery is limited. In this study, we describe the use of an endocardial pulsed-field ablation system for treating atrial fibrillation during mitral valve surgery. Two patients underwent mitral valve surgery and concomitant pulsed-field ablation using an endocardial monopolar probe. Ablation procedures were successfully performed in both patients. Electrophysiological studies confirmed the competence of all ablation lines. No device-related adverse effect was observed. After 12 months, the patients were in sinus rhythm, without documented atrial fibrillation paroxysms. The use of pulsed-field energy for atrial fibrillation treatment during open cardiac surgery demonstrated promising results in these two initial patients. However, given the preliminary nature of this report, these findings must be interpreted cautiously. Further studies with larger sample sizes are warranted.