Pulsed Field Ablation / PFA

Atrial fibrillation, also known as Afib, is a heart condition where the heart’s upper chambers beat quickly and irregularly instead of in a steady rhythm. This can feel like your heart is racing, or cause chronic fatigue, and it can lead to more serious problems like stroke or long-term heart failure. Current treatments for Afib include lifestyle changes, medications, and procedures like catheter ablation. A new treatment using irreversible electroporation (IRE) offers another often safer and more viable option for Afib treatment.

The Background

Even with the technology behind traditional thermal catheter ablation improving, there has been the nagging, albeit low risk, of heat or cold energy damage to structures surrounding the treatment area. These can include the esophagus, nerves, and blood vessels, all of which can be close to or within the treatment area. Pulsed-field ablation lowers the risks for complications compared to RF ablation (heat-based)
and cryoablation (cold-based) therapies.

Dr. Erik Sirulnik of Nevada Cardiology Associates and Dr Niuton Koide, MD, an electrophysiologist at Mountain View Hospital, performed the first cardiac ablation using a state-of-the-art technology called Pulse Field Ablation, or PFA. PFA is a safer way to deliver energy to the nerves of the heart to suppress atrial fibrillation.  This advanced technology was FDA-approved earlier this year but required expensive equipment, so it has taken some time to come to our state and city. We are grateful to Mountain View Hospital for committing to this new technology, and now, we are bringing this vital new procedure to Las Vegas.

>The Background

How It Works

Pulsed-field ablation (PFA) targets specific areas of the heart with short, high-intensity electrical pulses. These pulses are carefully controlled to destroy specific cellular structures in the area. In destroying these cells, we can disrupt the abnormal electrical signals responsible for causing Afib and restore a normal heart rhythm. PFA offers several potential advantages over traditional ablation methods. Because it does not rely on thermal (hot or cold) energy, PFA may reduce procedure times and complications due to tissue heating or cooling. PFA is more precise than other ablation options, thus limiting nearby tissue damage, improving outcomes, and even reducing the need for repeat procedures. Studies are also being conducted to understand if PFA can be employed without the need for full anesthesia, which would reduce the risk of treatment significantly, especially in older patients who may be more prone to complications associated with being put to sleep.

Outcomes

A recent study published in Circulation showed that PFA was effective for at least a year in 2/3 of patients with paroxysmal Afib and 1/2 with persistent Afib. These outcomes are comparable to those of other ablation procedures. The same study noted that serious adverse events occurred in less than 1% of participants. While many more studies will be needed to get accurate long-term US data on the comparable effectiveness of PFA, we are seeing excellent early results. That said, some patients will most benefit from thermal – particularly RF-based – ablation. Combination PFA and RF-based therapies are also in development.

>Outcomes

The Bottom Line

Atrial fibrillation affects millions of patients worldwide. Treatment for Afib is constantly
evolving, with new innovations offering improved patient outcomes and quality of life. Pulsed-field ablation (PFA) is a promising alternative to traditional treatment methods, offering a safer and more precise approach to restoring normal heart rhythm.