First-in-human case of repeat pulmonary vein isolation by targeting visual interlesion gaps using the direct endoscopic ablation catheter after single ring pulmonary vein isolation

Gaps between radiofrequency (RF) ablation lesions are the culprits for failed pulmonary vein isolation (PVI) leading to recurrent atrial arrhythmias. The ability to directly visualize in real time and eliminate interlesion gaps may improve the success of RF ablation by achieving contiguous linear ablation lesion sets. We aimed to describe to the best of our knowledge the first reported clinical case using the direct endocardial visualization (DEV) ablation catheter (Voyage Medical Inc., Redwood City, CA) to successfully reisolate pulmonary veins (PVs) by visually targeting interlesion gaps under direct endoscopic visualization during a clinical trial undertaken at our institution. The DEV catheter uniquely delivers RF energy using the virtual electrode. The virtual electrode can be conceptualized as the intervening saline column within the hood aperture in contact with the endocardial surface, thus preserving visualization of the target endocardium during ablation. The fiberscopic camera is located at the distal hood to visualize the endocardial surface as blood is purged away by the saline irrigation to create an unobstructed field of view (FOV).