Pulsed field ablation (PFA) is a new treatment that can be used to treat an arrhythmia, which is an irregular heartbeat. In PFA, a catheter will be placed in your heart that will deliver short-duration, high-voltage electrical pulses to destroy affected tissue in the heart or make the affected tissue inactive. Current PFA catheters have been developed specifically for atrial tissue to treat atrial arrhythmias.
How PFA Works and Why It’s Used
Since PFA uses high-intensity electrical pulses, affected cells in tissue in the heart that are contributing to an arrhythmia ultimately die due to protein damage, calcium overload and the inability to maintain function. Death of affected cells in damaged tissue can happen instantly but can also occur days after PFA occurs.
Research on PFA has enabled the current PFA catheters to be developed to specifically target affected tissue in the heart while helping the nerves and esophagus suffer as little damage as possible.
PFA is used to treat conditions like:
- Atrial fibrillation, which occurs when the heart’s upper chambers (atria) beat too fast, causing the heart to not be able to pump blood as effectively
- Ventricular tachycardia, which occurs when the heart’s lower chambers (ventricles) beat too fast
PFA creates durable, long-lasting effects, reducing the likelihood for patients to develop an arrhythmia in the future. Patients who receive PFA are generally able to have symptom-free lifestyles without the need to be on lifelong medications.
PFA has few complications compared to radiofrequency ablation, which uses heat, and cryoablation, which uses freezing energy. Radiofrequency ablation and cryoablation tend to affect organs around the heart, which can lead to complications like gastric ulcers, atrioesophageal fistula (a dangerous connection between the left atrium of the heart and the esophagus) and phrenic nerve palsy (paralysis of the diaphragm, a muscle that helps you breathe).
PFA Research
The first PFA catheter (PulseSelect™, Medtronic) was approved in December 2023, and clinical trials involving PFA have been occurring since 2021. Most clinical trials have been performed in patients with paroxysmal (resolving within seven days) and persistent (not resolving within seven days) atrial fibrillation.
Overall, only 0.2% of patients in the clinical trials have experienced complications. Rare complications that have been experienced include:
- Coronary spasm, which causes the blood vessels that supply oxygen and blood to the heart to narrow
- Ablation induced hemolysis, which causes red blood cells to break down
Fortunately, most patients with coronary spasm can have their spasm reversed. Research is being conducted to limit cases of ablation induced hemolysis. So far, it has been found that saline infusions can reduce the likelihood of ablation induced hemolysis.
It is possible for patients to have a slower-than-normal heartbeat (bradycardia) while receiving PFA. However, a medication called glycopyrrolate, along with temporary cardiac pacing, can be given to make brachycardia unlikely.
While more research continues to be conducted on PFA, it appears that it is a tool that can deliver safe, rapid and effective lesions. In studies that have been conducted so far, 66-82% of patients have successfully found relief from atrial fibrillation.
UofL Health Offers PFA
UofL Health – Heart Hospital, at UofL Health – Jewish Hospital, was among the first in Kentucky to adopt PFA technology for atrial fibrillation ablations. UofL Health has also been leading the way in performing fluoroless PFA ablations with extensive use of 3D mapping and intra-cardiac ultrasound, which is often inserted into the left atrium for better visualization of the PFA catheter during ablations.
UofL Physicians – Cardiology offers PFA for patients who have atrial fibrillation or ventricular tachycardia. Click here to see our heart care locations.
