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June 27, 2026EP EuropaceOpen Access

Pulsed-field ablation is linked to ~59% lower arrhythmic recurrence versus radiofrequency ablation.

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Why the study?

Evidence for pulsed-field ablation has largely focused on pulmonary vein isolation for AF, leaving its efficacy and safety compared to radiofrequency for left atrial macroreentrant flutter unclear.

Does electroporation (pulsed-field ablation) reduce clinical arrhythmia recurrence compared to radiofrequency ablation in patients with left atrial macroreentrant flutter post-AF ablation?

Population

89 patients with left atrial flutter appearing after or during AF ablation

Comparison

Electroporation (PFA) vs radiofrequency (RF) ablation

Design

Single-hospital ambispective observational study

Key result

Electroporation (pulsed-field ablation) significantly reduced arrhythmic recurrence at final follow-up compared to radiofrequency ablation (17.9% vs 44.0%, p=0.008).

Authors

CMC Arveras MartinezMFM T Izquierdo De FranciscoJMJ Navarro Manchon

Discussion

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Overview

PFA may be associated with lower recurrence than RF; hypothesis-generating, requiring randomized confirmation before practice change.

Key Points

  • The aim is to evaluate the efficacy and safety of electroporation for left atrial flutter management and compare it with radiofrequency ablation.
  • Ambispective observational study including 89 patients with left atrial flutter after AF ablation.
  • Radiofrequency was used in 50 patients, while 39 patients underwent pulsed-field ablation.
  • Survival analysis performed using Kaplan-Meier method with differences assessed via log-rank test.
  • Arrhythmia recurrence at 6 months was 31% for RF patients versus 12.8% for PFA patients (p < 0.05).
  • Final follow-up showed recurrence rates of 44% in RF vs 17.9% in PFA (p = 0.008).
  • Improved flutter-free survival in PFA group demonstrated with p = 0.015.

Study Design

Type

Observational (n=89)

Multicenter

No

Structured PICO

Does electroporation (pulsed-field ablation) reduce clinical arrhythmia recurrence compared to radiofrequency ablation in patients with left atrial macroreentrant flutter post-AF ablation?

P
Population
89 patients with left atrial macroreentrant flutter following atrial fibrillation ablation, treated with either electroporation or radiofrequency ablation.
E
Exposure
Electroporation (pulsed-field ablation) (n=39)
C
Comparator
Radiofrequency ablation (n=50)
O
Outcome
Clinical arrhythmic recurrence (including atrial fibrillation and left atrial flutter) at 6 months and final follow-upcomposite

Main Result

Absolute Event Rate: 17.9% vs 44%

p-value: p=0.008

Pulsed-field ablation is associated with significantly lower rates of arrhythmic recurrence and improved flutter-free survival compared to radiofrequency ablation for left atrial macroreentrant flutter.

Cite This Study

Martinez et al. (2026) conducted an observational in Left atrial macroreentrant flutter post-atrial fibrillation ablation (n=89). Electroporation (pulsed-field ablation) vs. Radiofrequency ablation was evaluated on Arrhythmic recurrence (including atrial fibrillation and left atrial flutter) at final follow-up (p=0.008). Electroporation (pulsed-field ablation) significantly reduced arrhythmic recurrence at final follow-up compared to radiofrequency ablation (17.9% vs 44.0%, p=0.008).

synapsesocial.com/papers/6a3f97bb125782b61d86597bhttps://doi.org/10.1093/europace/euag105.605
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