Chair Devi Nair (Jonesboro, US) led a live case discussion on enhanced redo atrial fibrillation (AF) ablation, featuring case operators Julian Chun and David Schaack (CCB Markus Krankenhaus, Frankfurt, DE). The panel, including Andreas Metzner (Hamburg, DE) and Andrea Sarkozy (Brussels, BE), explored the complexities of a 76-year-old patient undergoing her fourth AF ablation. The patient had persistent atrial tachycardia despite prior pulmonary vein isolation (PVI) and linear ablations. Prof Chun and Dr Schaack utilised the Sphere-9 catheter (Afera system) for high-density mapping and ablation, integrating pulsed field ablation (PFA) and radiofrequency ablation (RFA). They highlighted the catheter's flexibility, monopolar PFA capabilities and its role in mapping without switching devices.

The discussion focused on mapping strategies, scar identification and lesion durability. The team performed entrainment manoeuvres to confirm conduction pathways and targeted ablation of roof and anterior lines. The panel debated voltage cut-offs, the role of PFA in complex redo cases and its ability to penetrate scar tissue. The session concluded with successful termination of atrial tachycardia, demonstrating the efficacy of dual PFA-RFA integration in managing recurrent arrhythmias.