The session, 'HD Mapping LAT Post AF Ablation' featured a recorded case from CCB Markus Krankenhaus, Frankfurt, presented by case operator Stefano Bordignon, with session chair Roderick Tung (Phoenix, US), and panelists Arian Sultan (Cologne, DE) and Stylianos Tzeis (Athens, GR). A 79-year-old patient with paroxysmal atrial fibrillation (AF) had previously undergone pulsed-field ablation (PFA) using the pentaspline catheter and Frankfurt Olive Technique to improve pulmonary vein isolation (PVI) durability. The patient experienced left atrial flutter recurrence.

Using high-density (HD) mapping with the Orion basket catheter (64 electrodes), the team identified an atypical circuit near the vein of Marshall. Radiofrequency ablation (RFA) with the StablePoint catheter (40W) terminated the tachycardia. Additional lesions included a roof line and vein re-isolation. The 90-minute procedure (7 minutes fluoroscopy) had no complications, with discharge after two days.

The panel debated vein of Marshall ethanol infusion and high-resolution mapping, concluding that most centres prioritise PVI-first, with additional ablation only in proven recurrence.