Introduction
Catheter ablation is an increasingly used procedure to treat atrial
fibrillation (AF)1. Recently, a novel non-thermal
ablation modality, Pulse Field Ablation (PFA), has been introduced in
clinical practice2,3. During PFA, electrical pulses
are applied to the myocardium, inducing a destabilization of the cell
membrane, and then leading to the formation of nanoscale pores that
culminate in cell death; this phenomenon is called electroporation2,3. PFA is a cardio-selective ablation modality that
avoids thermal source-related complications2-5.
AF is responsible for about a quarter of ischemic
strokes1, and closure of the left atrial appendage
(LAA) is an alternative non-pharmacologic anti-thrombotic strategy in
patients who have contraindications to oral anticoagulants (OACs) or
patients with thrombo-embolic events, despite adequate OAC after other
plausible causes (e.g. carotid disease) have been
excluded6-9.
The prophylactic use of cerebral protection systems to prevent ischemic
stroke has been evaluated in patients undergoing transcatheter aortic
valve replacement10. As of today, we are lacking data
concerning the use of cerebral protection systems in patients undergoing
catheter ablation of AF; however, a clinical trial is underway
(NCT04685317). We present for the first time in Europe the case of a
patient with persistent AF with multiple recurrences of ischemic stroke
despite adequate therapy with OACs, who underwent transcatheter ablation
by PFA (FARAPULSE™ PFA System, Boston Scientific) combined with
simultaneous WATCHMAN FLXTM (Boston Scientific,
Marlborough, MA) implant and prophylactic use of a cerebral protection
system (SENTINELTM, Boston Scientific, Santa Rosa,
CA).