Efficacy, safety, and procedural outcomes of pulsed field ablation for cavotricuspid isthmus-dependent atrial flutter: a systematic review and single-arm meta-analysis.
Kartik Mehta, Heena Arshad, Inamullah Arshad et al.
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In 30 seconds
This systematic review and single-arm meta-analysis assessed pulsed field ablation (PFA) for cavotricuspid isthmus (CTI)-dependent atrial flutter in adults. Across 18 studies, the pooled rate of acute bidirectional CTI block was 98.1% (95% CI: 96.8-99.5; I 2 = 47.1%). Follow-up findings included 2.0% recurrence of typical flutter and 97.2% freedom from CTI-dependent flutter. Reported complication rates were generally low, although coronary vasospasm was more frequently reported and estimates were heterogeneous. The authors describe PFA as promising but note that larger prospective and randomized studies are needed to establish long-term efficacy and clinical utility.
Key findings
- Acute bidirectional CTI block was achieved at a pooled rate of 98.1% (95% CI: 96.8-99.5; I 2 = 47.1%).
- During follow-up, typical atrial flutter recurred in 2.0%; freedom from CTI-dependent flutter was 97.2% (I 2 = 0%).
- Coronary vasospasm was reported in 33.4%, with substantial heterogeneity; coronary artery stenosis occurred in 0.5%.
Why it matters
The pooled results suggest that PFA can achieve acute CTI block and maintain freedom from typical flutter in many treated patients. The safety findings also highlight coronary vasospasm as an outcome requiring attention when interpreting PFA experience. Because the evidence is predominantly observational and long-term efficacy remains uncertain, these estimates inform understanding of an emerging approach rather than establishing comparative benefit.
What to keep in mind
The evidence was predominantly observational, and the authors call for larger prospective and randomized trials to establish long-term efficacy and clinical utility.