First Clinical Experience With Reversible Electroporation Mapping in Atrial Flutter

BACKGROUND: Reversible pulsed field ablation (PF REV ) can temporarily block cardiomyocyte conduction, potentially identifying critical target sites before creating definitive lesions. However, PF REV local capture might interfere with the tachycardia mechanism. The aim of the study was to characterize the responses of nontriggered PF REV pulses to serve as a novel clinical mapping tool in reentrant atrial flutter. METHODS: PF REV pulses were delivered in and outside of the circuit using a 9-mm lattice-tip catheter in 30 reentrant atrial tachycardias in 26 patients. The presence of local capture and responses to PF REV pulses was characterized. RESULTS: Out of 163 PF REV pulses analyzed, 56 (34.4%) showed atrial capture and propagation. Propagated versus Nonpropagated PF REV cohorts were compared. The coupling interval of propagated PF REV pulses was significantly longer (195.3±69.2 msec versus 98.9±77.2 msec; P