Efficient Pulsed Field Ablation Workflow: Zero-Fluoroscopy Considerations, Tackling Secondary Arrhythmias (Flutters, Atrial Tachycardias)
Interview With Maheer Gandhavadi, MD
Interview With Maheer Gandhavadi, MD
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Maheer Gandhavadi, MD, Medical Director of Electrophysiology at Overlake Medical Center in Bellevue, Washington, discusses his session ahead of Heart Rhythm 2025, which takes place April 24-27, 2025.
Summarize the background and relevance of the topic.
Atrial fibrillation (AFib) is generally the most common arrhythmia encountered in an electrophysiology (EP) practice, with millions of individuals affected worldwide. An A-Fib clinic creates a pathway to optimize care for patients with AFib, including timely treatment of the arrhythmia. With increased awareness of AFib, optimal treatment is paramount. Pulsed field ablation (PFA) has shown significant promise over thermal ablation but has potential drawbacks, theoretically requiring increased use of fluoroscopy compared to thermal ablation (especially for those who previously performed radiofrequency ablation).
Tell us about your upcoming session and what you will be presenting on.
The session is called “The AFib Clinic: Streamlining Workflow for Busy Practices in the Era of PFA Technology.” The session is geared to practical management of AFib patients in busy community practices. I will be presenting on PFA for AFib, specifically, methods to perform PFA without use of fluoroscopy while still optimizing lesion efficacy. I will also touch on use of PFA for atrial arrhythmias other than AFib, in particular, how to approach and treat such rhythms when they arise during AFib ablation. I will try to reference techniques for use with multiple PFA and mapping systems currently available for practice in the United States.
What are the take-home messages you would like readers to leave with?
With small adjustments to workflow for intracardiac echocardiography and mapping, PFA can be performed effectively with minimal to no fluoroscopy. PFA is an excellent tool for treating atrial arrhythmias encountered during ablation of AFib, and particular types of macrorreentrant tachycardias predominate. These can be quickly identified and addressed without the need for additional catheters or methods of ablation.
