Abstract
Pulsed field ablation (PFA), a nonthermal ablative mechanism, has been proven to be effective and safe in clinical application. To date, PFA has been used for only atrial fibrillation (AF) ablation in limited clinical trials. The present study describes a case of paroxysmal AF in which mitral and cavotricuspid isthmus (CTI)-dependent atrial flutter was discovered incidentally during PFA operation and successfully ablated with PFA. This is the first medical record of PFA for AF combined with mitral and CTI atrial flutter. The present case report revealed that PFA can be independently used to treat complex arrhythmias, similar to radiofrequency (RF) ablation, without the need for assistance from other ablation methods. Concurrently, the present study, to the best of the authors' knowledge is the first to report a case using a point-to-point PFA ablation strategy for isthmus ablation. This highlights the potential of PFA in treating diverse arrhythmias across different regions, such as the mitral isthmus and other intricate areas, utilizing a point-to-point PFA ablation strategy.