Initial Single-Center Experience with Pulsed Field Ablation for Paroxysmal Atrial Fibrillation Targeting Pulmonary Veins and Superior Vena Cava

Objective To report the initial single-center experience of pulsed field ablation (PFA) for pulmonary vein isolation (PVI) and superior vena cava isolation (SVCI) in patients with paroxysmal atrial fibrillation (PAF). Methods Patients with paroxysmal atrial fibrillation who underwent their first pulsed ablation therapy from December 2024 to October 2025 were enrolled. Under general anesthesia and fluoroscopic guidance with digital subtraction angiography, pulsed ablation was performed to isolate the pulmonary veins and superior vena cava for treating paroxysmal atrial fibrillation. Activation mapping and pacing mapping were conducted before and after ablation of the pulmonary veins and superior vena cava. Results Twenty-four patients with paroxysmal atrial fibrillation (12 males, mean age 67.2 ± 16.3 years, left atrial anteroposterior diameter 39.1 ± 2.7 mm) were included. All 24 patients successfully completed pulsed ablation, achieving complete electrical isolation of all 96 pulmonary veins (100%) and all 24 superior vena cava (100%). Mean procedure time was 80.1 ± 19.4 minutes, with a mean ablation time of 95.6 ± 4.2 seconds. Four patients experienced transient vagal reflex during the ablation of the left superior pulmonary vein. No significant change in diaphragmatic excursion was observed. No periprocedural complications occurred, including pericardial effusion or coronary artery spasm. Conclusion This initial single-center experience demonstrates that pulsed field ablation for simultaneous pulmonary vein isolation and superior vena cava isolation in paroxysmal atrial fibrillation patients is effective, efficient, and safe.