Pulsed Field Ablation – A Revolution in Electrophysiology?

The specialty of electrophysiology is one of the most advanced in medicine and is primed for technological disruption by new and exciting therapies and procedures. After all, we are working with the heart’s electrical system rather than the body’s mechanics, as most other specialties do. With that said, the gold standard and potentially curative treatment for Afib and several other arrhythmias is a procedure known as cardiac catheter ablation. It is often more effective than front-line medical therapies, including antiarrhythmics.

Modern, currently available cardiac catheter ablations use thermal energy to ablate or destroy identified heart tissue causing errant electrical signals. Paroxysmal or occasional Afib treatment usually focuses on the pulmonary veins in the left atrium. In contrast, treatment for persistent and long-standing persistent Afib may be more diffuse within the chamber. One of the most significant drawbacks of thermal energy used to ablate heart tissue is the risk of damaging surrounding tissues, including nerves and esophageal tissue. This is a risk for both RF ablation, which uses heat, and cryoablation, which uses cold therapy. Fortunately, an experienced electrophysiologist can mitigate some of this risk.

Enter Pulsed Field Ablation

Pulsed field ablation uses short electrical to make the membranes of cells in the heart more porous, causing them to die and eventually be resorbed into the healthy heart tissue. Because of the short energy pulse, hardier cells, such as those in the esophagus or the nerves, are spared. The result is that pulse field ablation comes with minimal risk of injury to the surrounding structures. With an excellent safety profile and a growing number of studies to back up its safety record, pulse field ablation will be on our radars very soon.

Is This Procedure FDA-Approved?

Currently, two medical device companies have either completed or will be conducting trials on pulse field ablation. There is data to support the safety and effectiveness of pulse field ablation from Europe, where the procedure is already approved. However, the FDA must still consider its suitability for the American market. We expect PFA to be approved sometime in 2024 and should be available to patients shortly after.

Is PFA Indeed a Revolution In Cardiac Catheter Ablation?

This remains to be seen. While initial data shows excellent results, we have far more long-term data associated with cardiac catheter ablation. And while today’s cardiac catheter ablations come with some risks, they remain extremely safe and effective in the well-chosen patient. Of course, as electrophysiologists and cardiologists, we want many options, especially because there may be one method or technology most suitable for an individual patient.

Most importantly, if you are experiencing atrial fibrillation or any other cardiac arrhythmia, we encourage you to visit our office for a full workup and consultation. Arrhythmias are best treated early on before they progress to more treatment-resistant stages.