Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
Efficacy, safety, and procedural outcomes of pulsed field ablation for cavotricuspid isthmus-dependent atrial flutter: a systematic review and single-arm meta-analysis.
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Mehta Kartik, Arshad Heena, Arshad Inamullah, Abbas Muhammad, Ahuja Aarushi, Agrawal Priyal, Garg Lohit
Аннотация
BACKGROUND: Cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) is conventionally managed using radiofrequency catheter ablation. Pulsed field ablation (PFA) is an emerging non-thermal ablation technique using electroporation to create lesions across CTI. While it is well established for pulmonary vein isolation in atrial fibrillation, its effectiveness in CTI-dependent atrial flutter remains insufficiently characterized.
METHODS: This meta-analysis followed PRISMA guidelines, with a comprehensive search of databases through December 2025. Eligible studies included adult patients undergoing CTI ablation using PFA and reporting CTI-specific outcomes. Pooled event rates and means with 95% confidence intervals (CIs) were estimated using a random-effects model, with heterogeneity evaluated using the I2 statistic.
RESULTS: Eighteen studies were included. The pooled rate of acute bidirectional CTI block was 98.1% (95% CI: 96.8-99.5; I2 = 47.1%). Acute CTI reconduction occurred in 6.9%. During follow-up, recurrence of typical AFL was 2.0%, while freedom from CTI-dependent AFL was 97.2% (I2= 0%) and recurrence of any atrial tachyarrhythmia was observed in 4.2%. Safety outcomes showed low rates of coronary artery stenosis (0.5%), transient ST-segment elevation (0.8%), conduction disturbances (0.5%), and transient atrioventricular block (1.7%). Coronary vasospasm was more frequently reported (33.4%) with substantial heterogeneity. CTI ablation time was 7.9 min, and mean number of PFA applications was 10.6.
CONCLUSION: PFA demonstrates high procedural effectiveness in CTI-dependent atrial flutter, with good short-term durability and low complication rates. Despite predominantly observational data, PFA appears to be a promising approach for CTI ablation. Larger prospective and randomized trials are needed to establish its long-term efficacy and clinical utility.
METHODS: This meta-analysis followed PRISMA guidelines, with a comprehensive search of databases through December 2025. Eligible studies included adult patients undergoing CTI ablation using PFA and reporting CTI-specific outcomes. Pooled event rates and means with 95% confidence intervals (CIs) were estimated using a random-effects model, with heterogeneity evaluated using the I2 statistic.
RESULTS: Eighteen studies were included. The pooled rate of acute bidirectional CTI block was 98.1% (95% CI: 96.8-99.5; I2 = 47.1%). Acute CTI reconduction occurred in 6.9%. During follow-up, recurrence of typical AFL was 2.0%, while freedom from CTI-dependent AFL was 97.2% (I2= 0%) and recurrence of any atrial tachyarrhythmia was observed in 4.2%. Safety outcomes showed low rates of coronary artery stenosis (0.5%), transient ST-segment elevation (0.8%), conduction disturbances (0.5%), and transient atrioventricular block (1.7%). Coronary vasospasm was more frequently reported (33.4%) with substantial heterogeneity. CTI ablation time was 7.9 min, and mean number of PFA applications was 10.6.
CONCLUSION: PFA demonstrates high procedural effectiveness in CTI-dependent atrial flutter, with good short-term durability and low complication rates. Despite predominantly observational data, PFA appears to be a promising approach for CTI ablation. Larger prospective and randomized trials are needed to establish its long-term efficacy and clinical utility.