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Background <p>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.</p> Methods <p>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 I<sup>2</sup> statistic.</p> Results <p>Eighteen studies were included. The pooled rate of acute bidirectional CTI block was 98.1% (95% CI: 96.8–99.5; I<sup>2</sup> = 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% (I<sup>2</sup>= 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&#xa0;min, and mean number of PFA applications was 10.6.</p> Conclusion <p>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.</p> Graphical Abstract <p></p>

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Efficacy, safety, and procedural outcomes of pulsed field ablation for cavotricuspid isthmus-dependent atrial flutter: a systematic review and single-arm meta-analysis

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Kartik Mehta,
  • Heena Arshad,
  • Inamullah Arshad,
  • Muhammad Abbas,
  • Aarushi Ahuja,
  • Priyal Agrawal,
  • Lohit Garg

摘要

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.

Graphical Abstract