Arrhythmias & electrophysiology
Pulsed-Field Ablation of Atrial Flutter: Insights From a Large Volume U.S. Center
Authors' conclusion
PFA is a safe and effective modality for AFL ablation, achieving high acute success rates and favorable safety outcomes.
Study context
- Population
- Patients undergoing pulsed-field ablation (PFA) of atrial flutter (AFL) across subtypes
- Participants
- 311 patients368 AFLs
- Outcome
- Acute procedural success (AFL termination or bidirectional block across ablation lines)
Methodological detailsconsecutive patients, intracardiac echocardiography guidance
- Consecutive patients
- Intracardiac echocardiography guidance
Main finding
As reported in the abstract
Acute procedural success with PFA alone
Acute procedural success, PFA alone
96.5%
95% CI 94.03%–98.11%
Cavotricuspid isthmus-dependent flutters
99.5%
95% CI 97.34%–99.99%
Perimitral circuits
85.4%
95% CI 75.83%–92.20%
Observational data: associations, not effects.
Further findings
Adjunctive radiofrequency ablation required (circuits, predominantly perimitral AFLs)
- Circuits requiring adjunctive radiofrequency ablation
- 3.5%
AFL recurrence (after 90-day blanking) · median follow-up 175 days (Q1-Q3: 132-244 days)
- Recurrence, flutters
- 14 (3.9%; 95% CI: 2.17%-6.53%)
- Success rate, cavotricuspid isthmus-dependent flutters
- 98.5%
- Success rate, perimitral AFLs
- 90%
Safety
- Freedom from procedure-related adverse events
- 99% (95% CI: 97.21%-99.80%)
Original publication
Pulsed-Field Ablation of Atrial Flutter: Insights From a Large Volume U.S. Center. JACC Clin Electrophysiol. Published 13 August 2025. doi:10.
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