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Arrhythmias & electrophysiologyResearch article

First Clinical Experience With Reversible Electroporation Mapping in Atrial Flutter

Circ Arrhythm ElectrophysiolPublished

  • First clinical experience
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Authors' conclusion

PF REV mapping is a novel, feasible, and reproducible tool for identifying critical sites in reentrant atrial tachycardia with narrow isthmuses that may be improved through optimized triggering and dose titration.

Study context

Population
Patients with reentrant atrial tachycardias (atrial flutter); PF REV pulses delivered in and outside of the circuit using a 9-mm lattice-tip catheter30 reentrant atrial tachycardias in 26 patients, 163 PF REV pulses analyzed
Participants
26 patients
Comparison
Propagated versus Nonpropagated PF REV cohorts
  • Propagated PF REVn = 56

Main finding

As reported in the abstract

Atrial capture and propagation

PF REV pulses showing atrial capture and propagation, out of 163

56 (34.4%)

Further findings

Coupling interval · significantly longer with propagated

P < 0.001

Irregular TCL variations

P = 0.002

Responses to PF REV pulses (globally)

tachycardia termination
11.0%
stable tachycardia cycle length (tachycardia cycle length (TCL)) prolongation
9.8%
transient irregular TCL variations
3.1%
no change in activation sequence and TCL
76.1%

Specificity for localizing reentry circuit and critical isthmus

Termination or TCL prolongation only when delivered in the reentry circuit (specificity)
100%
Termination exclusively in the critical isthmus (specificity regardless of propagation)
100%
Stable TCL prolongation in the isthmus
93.8%
Stable TCL prolongation in the outer loop
6.2%
Specificity for nonpropagated PF REV to localize the isthmus
100%
Specificity for propagated PF REV to localize the isthmus
83.3%

Sensitivity of termination or stable TCL prolongation for identifying the critical isthmus

Sensitivity (moderate)
38.8%
Isthmus width
11.7±1.7 mm versus 22.9±2.1 mm
  • influenced by isthmus width, P <0.001

Reproducibility of PF REV pulses

Reproducibility (high)
82.9%

Original publication

First Clinical Experience With Reversible Electroporation Mapping in Atrial Flutter. Circ Arrhythm Electrophysiol. Published 2 February 2026. doi:10.1161/circep.125.014359
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Summarised from the published abstract; every number is checked against it