Rodriguez-Riascos Juan F, Vemulapalli Hema Srikanth, Muthu Padmapriya, Prajapati Poojan, Su Wilber, Shen Win-Kuang, Valverde Arturo M, Srivathsan Komandoor
Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Division of Cardiology, Banner-University Medical Center, University of Arizona College of Medicine, Phoenix, Arizona, USA.
J Cardiovasc Electrophysiol. 2025 Aug;36(8):2013-2024. doi: 10.1111/jce.16719. Epub 2025 May 28.
Cavotricuspid isthmus ablation (CTI) is a first-line therapy in patients with typical atrial flutter. With the advent of pulsed field (PF) as a new energy source, we sought to evaluate the use of PF for CTI ablation. A systematic literature search was conducted on the use of PF for CTI-flutter up to December 2024. A meta-analysis was performed for studies reporting pooled data, while individual case reports were reviewed and summarized. The mean number of PF applications, acute success rate, and prevalence of coronary vasospasm were evaluated. Eleven studies with pooled data from 155 patients were included. All patients had an acute block of the CTI. The mean number of PFA applications was 7.78 (95% CI 6.53-9.48). The incidence of ST-elevation was 0.04% (95% CI 0-2.23%). Subclinical vasospasm was documented in 45% (95% CI 32%-59%) of patients who underwent periprocedural coronary angiography. Prophylactic use of nitrates showed a trend toward reducing the incidence of subclinical vasospasm (RR 0.24, 95% CI 0.06-1.06, p = 0.059). Twelve cases with patient-level data were included; six reported complications, including ST elevation and conduction disturbances. PFA for CTI flutter demonstrates high acute success; however, evidence regarding the durability of the block is limited. Clinical vasospasm with ST segment elevation is uncommon but can lead to life-threatening complications. The incidence of subclinical vasospasm is high, and nitrates tend toward reducing this phenomenon. To date, the role of PFA for this condition appears to be limited.
三尖瓣峡部消融术（CTI）是典型心房扑动患者的一线治疗方法。随着脉冲场（PF）作为一种新能源的出现，我们试图评估PF在CTI消融中的应用。对截至2024年12月PF用于CTI心房扑动的情况进行了系统的文献检索。对报告汇总数据的研究进行了荟萃分析，同时对个别病例报告进行了回顾和总结。评估了PF应用的平均次数、急性成功率和冠状动脉痉挛的发生率。纳入了11项来自155例患者的汇总数据研究。所有患者的CTI均急性阻滞。PF消融术的平均应用次数为7.78次（95%可信区间6.53 - 9.48）。ST段抬高的发生率为0.04%（95%可信区间0 - 2.23%）。在接受围手术期冠状动脉造影的患者中，45%（95%可信区间32% - 59%）记录到亚临床痉挛。预防性使用硝酸盐显示出降低亚临床痉挛发生率的趋势（相对风险0.24，95%可信区间0.06 - 1.06，p = 0.059）。纳入了12例有患者层面数据的病例；6例报告了并发症,包括ST段抬高和传导障碍。PF用于CTI心房扑动显示出较高的急性成功率；然而，关于阻滞持久性的证据有限。伴有ST段抬高的临床痉挛并不常见，但可导致危及生命的并发症。亚临床痉挛的发生率很高，硝酸盐倾向于减少这种现象。迄今为止，PF在这种情况下的作用似乎有限。
