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Robotic Ablation of Atrial Fibrillation
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Safety, Efficacy, and Mid-Term Outcomes of Pulsed Field Ablation for Cavotricuspid Isthmus-Dependent Flutter:

Juan F Rodriguez-Riascos1, Hema S Vemulapalli1, Poojan Prajapati1

  • 1Division of Cardiovascular Diseases (J.F.R.-R., H.S.V., P.P., P.M., D.S., W.-K.S., H.E.M., M.S., A.M.V., K.S.), Mayo Clinic, Phoenix, AZ.

Circulation. Arrhythmia and Electrophysiology
|December 2, 2025
PubMed

Insights

Pulsed field ablation shows promise for treating cavotricuspid isthmus-dependent atrial flutter, achieving high acute success rates. Further research is needed to confirm long-term effectiveness and compare it with traditional methods.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Cavotricuspid isthmus (CTI) ablation is a common procedure for atrial flutter.
  • Pulsed field ablation (PFA) is a novel energy source rapidly gaining traction for atrial fibrillation treatment.
  • The efficacy of PFA for CTI-dependent atrial flutter (AFL) requires thorough evaluation.

Purpose of the Study:

  • To assess the procedural and clinical outcomes of CTI ablation using pulsed field energy.
  • To determine the feasibility and effectiveness of PFA in treating CTI-dependent AFL.
  • To identify potential limitations of PFA in CTI ablation.

Main Methods:

  • Retrospective analysis of 132 consecutive patients undergoing PFA for CTI-dependent AFL.
  • Primary endpoints included acute procedural success, periprocedural complications, and AFL recurrence.
  • Follow-up data was collected to assess long-term outcomes.

Main Results:

  • High acute procedural success rate of 99.2% for CTI block, with 8 patients needing adjunctive radiofrequency ablation.
  • Low incidence of periprocedural complications, including transient ST-segment elevation and conduction disturbances.
  • A 6-month typical AFL-free survival estimate of 93.6% with a low recurrence rate of 3.8%.

Conclusions:

  • Pulsed field ablation is a feasible and effective strategy for CTI-dependent AFL.
  • Anatomic variations may pose challenges for current PFA catheter designs.
  • Long-term durability and comparative efficacy against thermal ablation warrant further investigation.
Abstract

Keywords:
atrial fibrillationatrial fluttercathetersechocardiography

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