Direct Focal Pulsed Field Ablation of a para-Hisian Atrial Tachycardia Adjacent to the His Bundle

Para-Hisian atrial tachycardias (AT) remain challenging ablation targets because of their proximity to the cardiac conduction system. Contemporary thermal ablation in this anatomical region has been associated with a reported risk of permanent atrioventricular (AV) block of up to 14%, depending on the ablation approach (1) (2) (3). Pulsed field ablation (PFA) is a novel electroporation-based energy source with preferential myocardial tissue selectivity (4) (5) and may therefore offer advantages in anatomically sensitive regions.