Fuwai Central China Hospital Successfully Performs 3D-PFA + LAAC Combined Procedure for Severe Spinal Deformity

Clinical Pain Points & Technology Introduction Recently, the Arrhythmia Team at Fuwai Central China Cardiovascular Hospital successfully performed a combined 3D Pulsed Field Ablation (3D-PFA) and Left Atrial Appendage Closure (LAAC) procedure under general anesthesia for a high-risk atrial fibrillation (AF) patient with severe ankylosing spondylitis (AS) and renal insufficiency.

Technical Background: Thoracic anatomical remodeling and supine intolerance caused by severe skeletal deformities have long been considered contraindications for electrophysiological interventions. To break through this clinical bottleneck, the team introduced non-thermal PFA and real-time intracardiac echocardiography (ICE) imaging, establishing a dual defense of rhythm control and stroke prevention for high-risk, complex AF patients.

Standardized Surgical Pathway & Technical Breakdown The successful execution of this procedure marks a further refinement in the comprehensive intervention pathway for complex arrhythmias. The core technical steps are as follows:

1. Individualized Anesthesia & Posture Management: A customized semi-recumbent general anesthesia protocol was implemented to accommodate the severe kyphoscoliosis, ensuring airway and hemodynamic stability during the procedure.
2. 3D Reconstruction Overcoming Anatomical Variations: Utilizing a high-precision 3D mapping system, the team overcame major vascular anomalies and cardiac displacement to accurately construct a 3D electroanatomical model of the left atrium.
3. Tissue-Selective PFA: Irreversible electroporation (IRE) technology was applied to achieve rapid electrical isolation of the pulmonary veins, effectively avoiding the esophageal and phrenic nerve injuries commonly associated with traditional RF ablation in distorted anatomies.
4. Zero/Low-Contrast LAAC Implantation: Leveraging the "what you see is what you get" capability of ICE, the LAAC device was deployed under an extremely low contrast load, successfully preserving intraoperative renal function.

Advancement & Clinical Value This procedure not only cured the patient's long-standing AF but also established a standardized interventional paradigm for patients with "severe anatomical deformities + multi-organ dysfunction." Empowered by the cutting-edge technology matrix of "3D Mapping + PFA + ICE + LAAC," Fuwai Central China Cardiovascular Hospital continues to expand the boundaries of complex arrhythmia interventions, providing safer and more durable clinical benefits for high-risk patients.