Pulsed Field Ablation in the Coronary Sinus: Feasibility and Safety of a Novel Approach for Mitral Isthmus Block

The study population consists of 30 consecutive participants who underwent catheter ablation for atrial fibrillation at Zhongshan Hospital, Fudan University. This cohort includes:

• Clinical Presentation: The group is composed of paroxysmal atrial fibrillation and persistent atrial fibrillation.
• Age Profile: All participants are between 18 and 75 years of age.
• Treatment Context: Every patient in this population required substrate modification involving linear ablation at the mitral isthmus (MI) and within the coronary sinus (CS).
• Health Status: The population excludes individuals with severe heart failure (NYHA Class III or IV), advanced renal failure eGFR<30mL/min/1.73m²), or a history of heart surgery and left atrial appendage occlusion

Inclusion Criteria:

• Symptomatic Atrial Fibrillation: participants must have a diagnosis of symptomatic paroxysmal or persistent atrial fibrillation.
• Documentation: The arrhythmia must be documented by electrocardiogram or Holter monitoring.
• Age Range: participants must be between 18 and 75 years of age.
• Study Compliance: participants must be willing and able to comply with the post-procedural follow-up schedule.
• Procedural Requirement: All patients must be candidates for linear ablation at the mitral isthmus (MI) and coronary sinus (CS) for substrate modification.

Exclusion Criteria:

• Prior Cardiac Procedures: Patients with a history of prior heart surgery or Left Atrial Appendage Occlusion (LAAO) are excluded.
• Heart Failure Severity: Individuals classified with New York Heart Association (NYHA) functional class III or IV are ineligible.
• Renal Impairment: Patients with advanced renal failure, defined as an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73m², are excluded.
• Intracardiac Thrombus: Any patient with a left atrial thrombus identified via transesophageal echocardiography (TEE) is excluded.