{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:52:39Z","timestamp":1784641959899,"version":"3.55.0"},"reference-count":19,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Pulse field ablation (PFA) is a novel ablation technology with efficacy and safety, potentially making it a preferred ablation technology for persistent atrial fibrillation (AF). There is no optimal procedural workflow established to optimize efficacy, limiting the number of PFA applications and risks of the procedure. Due to the importance of optimal catheter\u2013tissue contact for effective pulse field ablation, a workflow combining superior left atrial intracardiac echo (ICE) imaging and electroanatomic mapping (EAM) is an attractive strategy for PFA of persistent AF. Methods: A detailed procedural workflow was developed for fluoroscopy-free PFA using a pentaspline ablation catheter supported by left atrial ICE and EAM, and a case series of its execution in 30 consecutive patients with persistent AF is presented. All patients underwent pulmonary vein and posterior wall isolation as the index procedure, followed by additional ablation targeting non-pulmonary vein triggers and other inducible atrial arrhythmias. Results: Left atrial ICE imaging and EAM guided procedure resulted in successful isolation of the pulmonary veins and posterior wall in all patients, with additional ablation of spontaneous arrhythmias or non-pulmonary triggers if induced. There were no major complications of the procedure. Average procedure times and short-term efficacy were comparable with reported PFA outcomes using traditional imaging techniques. Conclusions: Fluoroscopy-free PFA guided by left-sided ICE for persistent AF can be performed with superior catheter\u2013tissue contact imaging in a safe manner with a comparable procedural time and short-term efficacy as reported with the use of other imaging modalities.<\/jats:p>","DOI":"10.3390\/jcdd12100412","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T07:33:50Z","timestamp":1760686430000},"page":"412","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Fluoroscopy-Free Ablation Workflow for Persistent Atrial Fibrillation Using a Pentaspline Pulse Field Ablation Catheter Guided by Left-Sided Intracardiac Echo Imaging and Electroanatomic Mapping: A Case Series"],"prefix":"10.3390","volume":"12","author":[{"given":"Adam","family":"Mohmand-Borkowski","sequence":"first","affiliation":[{"name":"Department of Cardiology, Cape Cod Hospital, 25 Main Street, Hyannis, MA 02601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.1016\/j.hrthm.2025.01.044","article-title":"Which ablation strategy is the most effective for treating persistent atrial fibrillation? A systematic review and bayesian network meta-analysis of randomized controlled trials","volume":"22","author":"Zheng","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1093\/europace\/euac050","article-title":"Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)","volume":"24","author":"Ekanem","year":"2022","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/CIRCULATIONAHA.123.064959","article-title":"Safety and effectiveness of pulsed field ablation to treat atrial fibrillation: One-year outcomes from the MANIFEST-PF registry","volume":"148","author":"Turagam","year":"2023","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e011780","DOI":"10.1161\/CIRCEP.122.011780","article-title":"Paroxysmal atrial fibrillation ablation using a novel variable loop biphasic pulsed field ablation catheter integrated with a 3-dimensional mapping system: 1-year outcomes of the multicenter inspIRE study","volume":"16","author":"Duytschaever","year":"2023","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1016\/j.hrthm.2024.04.102","article-title":"AF ablation using a novel \u201csingle-shot\u201d map-and-ablate spherical array pulsed field ablation catheter: 1-Year outcomes of the first-in-human PULSE-EU trial","volume":"21","author":"Turagam","year":"2024","journal-title":"Heart Rhythm"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"euad185","DOI":"10.1093\/europace\/euad185","article-title":"EUropean real-world outcomes with Pulsed field ablation in patients with symptomatic atrial fibrillation: Lessons from the multi-centre EU-PORIA registry","volume":"25","author":"Schmidt","year":"2023","journal-title":"Europace"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"euad086","DOI":"10.1093\/europace\/euad086","article-title":"Safety and efficacy of intracardiac echocardiography-guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: A prospective randomized controlled trial","volume":"25","author":"Ahn","year":"2023","journal-title":"Europace"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Debreceni, D., Janosi, K., Bocz, B., Turcsan, M., Lukacs, R., Simor, T., Antolic, B., Vamos, M., Komocsi, A., and Kupo, P. (2023). Zero fluoroscopy catheter ablation for atrial fibrillation: A systematic review and meta-analysis. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1178783"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.hroo.2022.08.001","article-title":"Safety of continuous left atrial phased-array intracardiac echocardiography during left atrial ablation for atrial fibrillation","volume":"3","author":"Jackson","year":"2022","journal-title":"Heart Rhythm O2"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/jce.15813","article-title":"Effect of contact force on pulsed field ablation lesions in porcine cardiac tissue","volume":"34","author":"Mattison","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/pace.14860","article-title":"Zero-fluoroscopy ablation with multielectrode pulse field ablation system: Case series","volume":"47","author":"Rauber","year":"2024","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1002\/joa3.13174","article-title":"Workflow of the zero-fluoro pulsed field ablation","volume":"40","author":"Hirata","year":"2024","journal-title":"J. Arrhythmia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E875","DOI":"10.1016\/j.hrthm.2025.05.045","article-title":"Ensuring catheter-tissue contact with intracardiac echocardiography during pulsed-field ablation improves procedure outcome in patients with atrial fibrillation","volume":"22","author":"Mohanty","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.jacep.2023.12.015","article-title":"Nitroglycerin to Ameliorate Coronary Artery Spasm During Focal Pulsed-Field Ablation for Atrial Fibrillation","volume":"10","author":"Malyshev","year":"2024","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_15","first-page":"1746","article-title":"NEMESIS-PFA Investigating Collateral Tissue Injury Associated with Pulsed Field Ablation","volume":"11","author":"Lakkireddy","year":"2025","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_16","first-page":"1664","article-title":"Pulsed Field Ablation for Persistent Atrial Fibrillation: 1-Year Results of ADVANTAGE AF","volume":"85","author":"Reddy","year":"2025","journal-title":"JACC"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s10840-023-01699-2","article-title":"Intracardiac echocardiography-guided pulsed-field ablation for successful ablation of atrial fibrillation: A propensity-matched analysis from a large nationwide multicenter experience","volume":"67","author":"Russo","year":"2024","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.jacep.2024.11.009","article-title":"Results of ICE-Guided Isolation of the Superior Vena Cava with Pulsed Field Ablation","volume":"11","author":"Pierucci","year":"2025","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6268","DOI":"10.19102\/icrm.2025.16052","article-title":"An Antiquated Concept in the Novel Era of Ablation: Zero-fluoroscopy Pulsed Field Ablation for Treatment of Atrial Fibrillation","volume":"16","author":"Harmouch","year":"2025","journal-title":"J. Innov. Card. Rhythm. Manage."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/10\/412\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T08:14:58Z","timestamp":1760688898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/10\/412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":19,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcdd12100412"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12100412","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]}}}