Pulsed Field Ablation of the Cavotricuspid Isthmus During Pulmonary Vein Isolation: Efficacy, Safety, and Procedure Duration

Pulsed field ablation (PFA) is a non-thermal technology that has rapidly entered the practice of catheter treatment of atrial fibrillation (AF) owing to its tissue selectivity and short application time. Its use for cavotricuspid isthmus (CTI) ablation in concomitant atrial flutter is less well studied.Аim. To assess the efficacy, safety and duration of pulsed field ablation of the CTI performed during pulmonary vein isolation (PVI) in patients with AF.Materials and methods. Data from 285 patients with AF who underwent catheter ablation using PFA were analyzed. CTI ablation was performed in 133 (46.7%) patients: radiofrequency (RFA) in 85 (63.9%), pulsed field in 36 (27.1%), and hybrid in 12 (9.0%). Achievement of bidirectional block, procedure duration, number of applications, and complications were assessed.Results. Pulsed field ablation of the CTI achieved bidirectional block in all cases with a median of 6 applications (interquartile range 6-8). The total procedure time in the PFA CTI group was significantly shorter than with RFA: median 52 versus 72 minutes (p<0.001). No serious complications occurred; one case of transient right coronary artery spasm was successfully resolved by intravenous nitrate administration. In hybrid ablation, the RFA → PFA sequence predominated (7 of 12), whereas the reverse transition was less frequent.Conclusions. Pulsed field ablation of the CTI during PVI is an effective and safe method that achieves bidirectional block with few applications and substantially shortens procedure duration compared with radiofrequency ablation.