Key result
A single reversible PFA pulse identifies the critical isthmus and terminates tachycardia before irreversible ablation.
Why the study?
The utility of reversible electroporation in cardiac ablation is unknown.
Can reversible electroporation using a single pulse of pulsed field ablation identify the critical isthmus and terminate arrhythmia in a patient with atypical atrial flutter?
Case Report (n=1)
No
Can reversible electroporation using a single pulse of pulsed field ablation identify the critical isthmus and terminate arrhythmia in a patient with atypical atrial flutter?
Reversible electroporation using a single pulse of pulsed field ablation can be utilized to test areas of interest and identify critical isthmuses prior to creating irreversible lesions in complex arrhythmias.
May support reversible PFA for isthmus mapping in atypical flutter; hypothesis-generating pending prospective trials.
Pulsed field ablation uses irreversible electroporation to interrupt cellular membranes and induce myocyte apoptosis. Reversible electroporation has been used in other specialties, but its utility in cardiac ablation is unknown. Here, a 69-year-old woman undergoing repeat ablation for atypical atrial flutter presented with extensive scar after cardiac surgery (including MAZE) and previous ablation, leading to a macro re-entry circuit. To minimize superfluous lesions and further arrhythmia, we used a single pulse confirming the isthmus location, with cessation of the arrhythmia. As a conclusion, reversible electroporation may be used to test areas of interest prior to irreversible lesion creation.
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Mannion et al. (2025) conducted a case report in Atypical atrial flutter (n=1). Reversible pulsed field ablation (PF-rev) was evaluated on Termination of tachycardia and restoration of sinus rhythm. A single pulse of reversible pulsed field ablation successfully identified the critical isthmus and terminated the re-entry tachycardia, restoring sinus rhythm prior to irreversible lesion creation.
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