An Antiquated Concept in the Novel Era of Ablation: Zero-fluoroscopy Pulsed Field Ablation for Treatment of Atrial Fibrillation.

Intracardiac echocardiography (ICE) is a common tool that has real-time impact in novel pulsed-field ablation (PFA). It is a feasible and efficient option due to zero-fluoroscopy, real-time tissue visualization of procedural maneuvers, and for the assessment of potential procedural complications. We present a case of zero-fluoroscopy-based PFA using four-dimensional (4D) ICE in a 68-year-old man with symptomatic atrial fibrillation. Using 4D ICE, we were able to achieve procedural success by visualization of direct tissue contact with the Farawave™ catheter (Boston Scientific, Marlborough, MA, USA) with each rotation and application of the basket and flower configurations and no edema or color change in tissue morphology after applications. Overall, zero fluoroscopy in PFA is feasible and efficient.