Safety and outcomes of pulsed field ablation in the management of supraventricular arrhythmia: A systematic review

Abstract

Introduction: Pulsed field ablation (PFA) is an emerging non-thermal ablative technology that induces irreversible electroporation to selectively target cardiac tissue while minimizing damage to adjacent structures. While widely studied for atrial fibrillation, its role in managing supraventricular tachycardia (SVT) remains unclear. This systematic review aims to consolidate existing data on the safety and efficacy of PFA for SVT ablation.

Methods: A comprehensive literature search was conducted to identify studies reporting PFA outcomes in SVT. Inclusion criteria encompassed studies involving AVNRT, AVRT, and atrial tachycardia (AT). Data on procedural success, complications, and recurrence rates were extracted and analyzed. The review included 10 studies, comprising 3 case reports and 7 prospective studies, involving a total of 312 patients.

Results: PFA demonstrated a high acute procedural success rate of 97.6 %. Success rates varied by SVT type: AVNRT (99.8 %), AVRT (98.7 %), and AT (96.1 %). Transient atrioventricular (AV) block, primarily during slow pathway ablation for AVNRT, occurred in 19.3 % of cases, with most resolving within 24 h. No permanent AV block or major procedural complications were reported. Recurrence rates were 9.6 % overall after six months, with AT exhibiting a higher recurrence rate of 21.4 %. Challenges with lesion durability, particularly in linear ablations, were noted, sometimes requiring adjunctive radiofrequency catheter ablation (RFCA). PFA's tissue selectivity proved beneficial in complex SVT cases near critical structures like the phrenic nerve and right atrial appendage, where RFCA posed higher complication risks.

Conclusions: PFA shows promise as an effective and safe alternative to RFCA for SVT, particularly in challenging anatomical locations. Despite its high acute success rates and favorable safety profile, concerns about lesion durability and recurrence-especially in AT-necessitate further investigation. Larger, multicenter studies with standardized protocols are essential to optimize outcomes and clarify PFA's role in SVT ablation.

Keywords: Catheter ablation; Outcomes; Pulsed filed ablation; Supraventricular tachycardia.