How to Use a Variable Loop Circular Catheter to Perform Zero Fluoro Pulmonary Vein Isolation With Pulsed Field Ablation

ABSTRACT Background The variable loop circular catheter (VLCC) called VARIPULSE is a novel device designed for catheter ablation of atrial fibrillation (AFib) and electro‐anatomical mapping via 3D intracardiac echocardiography (ICE). Described herein is a streamlined workflow for AFib ablation and reported feasibility, procedural efficiency, and early safety signals of the first 34 consecutive patients. The technical details of step‐by‐step techniques are described to serve as a practical guide for clinicians and investigators. Methods A retrospective, single‐center review of procedural parameters was done on 34 paroxysmal and/or persistent AFib patients who were treated with a VLCC for both mapping and ablating between January 1, 2025 and May 15, 2025. The workflow of all procedures was comprised of general anesthesia administration, placement of 2 sheaths via ultrasound guided access, administration of a heparin bolus, 3D anatomical mapping of the pulmonary veins with CARTOSOUND FAM, a transeptal puncture, VLCC ablation, and then closure. Figures illustrating key procedural steps, including catheter maneuvering, are included. Results All 34 cases were done without fluoroscopy, with a median procedural time of 40.5 IQR 19 min. After 10 procedures per operator, consistently shorter procedure times (<45min) were achieved. No major acute or 30‐day complications were observed. Conclusion This review of the initial 34 patients undergoing ICE and cardiac ablation using the VLCC catheter, exhibits a fluoroless, streamlined workflow that is feasible and operationally efficient, with early safety signals that require validation in larger, prospective studies. Notably, this approach did not require multiple transvenous access sites, pre‐procedural cross‐sectional imaging, right atrial matrix, or additional multielectrode catheters that would necessitate frequent catheter‐cable switching.