Pulsed field ablation as first-line treatment to reduce atrial fibrillation burden documented by pacemaker.

Pulsed field ablation (PFA) using high-voltage electrical energy is a novel and powerful ablation modality. However, PFA as a first-line rhythm control in atrial fibrillation (AF) has been rarely described; whether PFA interacts with the pacemaker (PM) has been seldom reported. We reported PFA of AF in a patient with PM who needed effective rhythm control. Pulmonary vein isolation (PVI) was successfully performed without complication, and the procedure was extremely fast (skin-to-skin 25 min.) with short fluoroscopic time (3.9 min). PFA had no influence on the PM function. Six months' follow-up showed good clinical outcome and significantly decreased AF burden.