Chair Suneet Mittal (New York, US) led a session on radiofrequency (RF) ablation and mapping for paroxysmal atrial fibrillation (PAF), featuring case operator Rodney Horton (Austin, US) and panellists Luigi Di Biase (New York, US) and Pasquale Santangeli (Cleveland, US). The session focused on using the Qdot ablation catheter for precise lesion placement. The case involved a 23-year-old patient with cor triatriatum and atypical flutter undergoing pulmonary vein isolation (PVI). A dual transseptal approach was used with intracardiac echocardiography guiding positioning. The Qdot system provided real-time temperature monitoring and optimised lesion depth, while an oesophageal probe ensured safety. Horton demonstrated a fluoroless procedure using electroanatomic mapping.

The panel discussed RF ablation’s role in the era of pulse field ablation (PFA), highlighting RF’s precision in lesion depth control. Horton emphasised steam pop prevention through catheter angle and power adjustments. Safety measures, including optimal indifferent electrode placement, were reviewed. The panel debated RF versus PFA for atypical flutter, with Horton favouring PFA’s broad footprint but recognising RF’s superior deep structure targeting. The session concluded with insights on ICE-guided workflows for fluoroless procedures, optimising safety and efficiency.