Long-Term Outcome After Pulsed Field Ablation for Atrial Fibrillation Across an Atrial Septal Defect Closure Device: A 20-Month Follow-Up Case Report.

Balloon-assisted transseptal puncture across a large atrial septal defect closure device can permit pulsed-field ablation in selected patients with complex septal anatomy, achieving durable pulmonary vein isolation and sinus rhythm. A borderline residual left-to-right shunt developed post-procedure but decreased on serial imaging without hemodynamic consequence.