Chair and Case Operator Devi Nair (Jonesboro, US) led this session on zero-fluoroscopy pulsed field ablation (PFA) workflows, integrating intracardiac echocardiography (ICE) and 3D mapping for enhanced precision. She was joined by panellists Daniel Alyesh (Denver, US), John Day (Salt Lake City, US), and Oussama Wazni (Cleveland, US). The session demonstrated a case using the Farapulse and PulseSelect PFA systems with the NSight X mapping system. Dr Nair outlined how 3D mapping and ICE improve catheter positioning and lesion overlap while eliminating fluoroscopy. The case involved an 82-year-old patient with long-standing persistent atrial fibrillation and prior ablation. Given her history of atypical flutter, the team performed a comprehensive PFA approach, including posterior wall, SVC, and mitral isthmus ablation.

The panel discussed zero-fluoroscopy workflows, lesion durability, and strategies to prevent mitral flutter. They explored additional techniques like vein of Marshall ethanol ablation and ICE-guided transseptal puncture. Dr Nair emphasised the occupational benefits of eliminating lead exposure. The session reinforced that PFA procedures can be safely performed without radiation.