Pulsed Field Ablation of Macro-Reentrant Atrial Tachycardia Involving the Persistent Left Superior Vena Cava.

A 51-year-old man with a persistent left superior vena cava (PLSVC) underwent catheter ablation using the PulseSelect PFA Loop catheter (Medtronic). During the procedure, sustained atrial tachycardia (AT) was observed and identified as a macro-reentrant circuit involving the PLSVC. Pulsed field ablation (PFA) applied within the PLSVC successfully terminated the AT without complications. This is a case of macro-reentrant AT involving the PLSVC-left atrium epicardial connection, in which both intracardiac mapping and treatment were performed only using PFA, demonstrating its potential as a safe and effective therapeutic strategy in this challenging anatomical context.