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Pulsed Field Ablation

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Pulsed Field Ablation

Catheter ablation is a treatment option for cardiac arrhythmias. Conventional methods use thermal energy—either heat (radiofrequency ablation) or cold (cryoablation)—to destroy abnormal heart tissue causing the irregular rhythm. However, these approaches can sometimes damage nearby healthy tissue as well.

What is Pulsed Field Ablation (PFA)?

PFA, or Pulsed Field Ablation, is an innovative technique in cardiac electrophysiology for treating arrhythmias. Unlike traditional thermal energy, PFA uses pulsed electric fields (PEF) to induce irreversible electroporation (IRE). This approach selectively destroys abnormal heart tissue while preserving the structural integrity of surrounding healthy tissue.

Pulsed Field Ablation​

The image displays three distinct techniques for ablation:

  1. Radiofrequency ablation (RFA).
  2. Cryoablation
  3. Pulsed field ablation (PFA)

Image source: International Journal of Cardiology

What kind of disease and undergoes PFA treatment?

Clinical trials have shown that PFA holds promising potential for treating symptomatic, drug-resistant, recurrent atrial fibrillation (AFib). It is associated with fewer complications compared to conventional thermal methods, while maintaining effectiveness. As a result, several catheter platforms utilizing electroporation have been developed and tested for catheter ablation, particularly for AFib.

How does PFA work?

Pulsed Field Ablation (PFA) works by creating small areas of damage in heart tissue through a process called irreversible electroporation (IRE). When the heart cells are exposed to strong electrical pulses, their membranes become more porous, causing the cells to die without harming the surrounding tissue or structure.

How does PFA work

Mechanism of cardiomyocyte death induced by electroporation process
Image source: IMR press

What are the Advantages and Complication of PFA?

PFA demonstrated a very low incidence of procedure-related adverse events. It minimizes the incidence of thermal-specific injuries, mainly the oesophagus and nerves injury, in preclinical and clinical studies.

From a technical perspective, PFA was associated with shorter procedure times and reduce x-ray exposure. Also, PFA have shown in achieved a freedom from procedural failure, arrhythmia recurrence, or escalation of antiarrhythmic drugs consistent with thermal ablation modalities.

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References:

  1. Verma A, Haines DE, Boersma LV, et al. Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial. Circulation. 2023;147(19):1422-1432. 
    doi: https://doi.org/10.1161/circulationaha.123.063988 
  2. Chun KRJ, Damijan Miklavčič, Vlachos K, et al. State-of-the-art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective. EP Europace. 2024;26(6).
    doi: https://doi.org/10.1093/europace/euae134