1Department of Cardiology, Meenakshi Medical College Hospital & Research Institute, Meenakshi Academy of Higher Education and Research
2Department of Cardiology, Meenakshi College of Allied Health Sciences & Meenakshi Medical College Hospital & Research Institute, Meenakshi Academy of Higher Education and Research
3Meenakshi College of Pharmacy, Meenakshi Academy of Higher Education and Research
4Department of Pharmacology, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research
5Arulmigu Meenakshi College of Nursing, Meenakshi Academy of Higher Education and Research
6Meenakshi College of Physiotherapy, Meenakshi Academy of Higher Education and Research
Background: Atrial flutter (AFL) is a typical macro reentrant atrial arrhythmia mostly ablated using catheters against the cavotricuspid isthmus (CTI). The traditional thermal sources of energy, which are radiofrequency (RF) and cryoablation, are efficient, but their usability has the threat of collateral tissue damage, such as vascular damage, atrioventricular nodal damage, and the esophageal or phrenic nerve damage. Pulse-field ablation (PFA) is a recent type of nonthermal, tissue selective energy modality based on irreversible electroporation of cardiac tissue with minimal collateral damage. Although PFA has demonstrated favorable outcomes in atrial fibrillation, the outcome of PFA in atrial flutter has been limited.
Objective: To assess the safety, acute efficacy and procedural outcome in pulse-field ablation in patients with standard atrial flutter, and to compare the results with those produced by standard thermal ablation procedures.
Methods: It was a prospective, comparative study involving patients who were undergoing catheter ablation to cure atrial flutter that was normally caused by CTI. Participants were randomly put in either PFA or traditional ablation (RF or cryothermal) as a result of the selection of operators and the presence of devices. The main outcomes were acute bidirectional CTI block, time of procedure, and fluoroscopy time. Such secondary endpoints as complications, early recurrence of arrhythmias, and 30 and 90 days outcomes were also evaluated. The 3D electroanatomic mapping technique was employed in all procedures and the application of PFA lesions was done by a multielectrode biphasic-pulse system with atrial tissue selectivity.
Results: There were 126 patients given (PFA: n = 62; RF/cryo: n = 64). ACL CTI block was developed on acute and bilateral directions in 100% and 98% of PFA and conventional ablation cases respectively (p = 0.31). PFA was associated with much less procedural time (median 28 vs. 42 minutes, p < 0.001) and myocardial lower levels of fluoroscopy exposure (4 vs. 11 minutes, p < 0.001). There were no performance of significant complications in the PFA group and three minor vascular complications and one transient phrenic neuropraxia in the conventional group (p = 0.04). There was no difference in the early levels of recurrence at 30 and 90 days (p > 0.05). There were no esophageal and coronary or phrenic nerve injuries that occurred with PFA.
Conclusion: The application of pulse-field ablation is safe, quick and a very effective method of treatment of the standard atrial flutter. PFA is much faster than conventional thermal ablation, less exposed to fluoroscopy and has a better safety profile, and the short term efficacy is similar. The results suggest the use of PFA as a next-generation modality of CTI ablation.
Keywords: Pulse-field ablation, irreversible electroporation, atrial flutter, CTI ablation, catheter ablation, electrophysiology, safety, efficacy, radiofrequency ablation, cryoablation
How to cite this article: Aashish A, Rose S, Chamundeeswari D, Packirisamy S, Kalpana P, Kumar KN. Pulse-Field Ablation in Atrial Flutter: Safety, Efficacy and Comparison with Conventional Ablation. Int J Drug Deliv Technol. 2026;16(10s): 209-217; DOI: 10.25258/ijddt.16.10s.31
Source of support: Nil.
Conflict of interest: None