ArticleHeart rhythm O22026
Efficacy and safety of pulsed field ablation for cavotricuspid isthmus-dependent atrial flutter: A meta-analysis based on real-world evidence.
Article in Heart rhythm O2, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: Pulsed field ablation (PFA) is effective for atrial fibrillation, but its real-world performance for cavotricuspid isthmus (CTI)-dependent atrial flutter remains inadequately defined. Objective: The purpose of this study was to systematically evaluate the efficacy and safety of PFA for CTI ablation using real-world evidence. Methods: A total of 9 observational studies (656 patients) published up to January 2026 were analyzed using a random-effects model. Results: Pooled analysis revealed a short-term bidirectional CTI block rate of 99.4% and a short-to-midterm recurrence rate of 2.14%. Mean CTI ablation time was highly efficient (8.86 minutes). Incidences of catastrophic complications and permanent atrioventricular block were 0%. The overall incidence of intraprocedural right coronary artery spasm was 2.0%. Prophylactic high-dose intravenous nitroglycerin (>1 mg) significantly reduced coronary spasm incidence compared with low-dose (≤1 mg) regimens (1% vs 8%; Conclusion: PFA is a rapid, safe, and highly effective modality for CTI ablation. The risk of transient coronary spasm may be mitigated with prophylactic high-dose nitroglycerin. These hypothesis-generating findings warrant further validation.
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