Pulse field ablation offers new option for atrial fibrillation patients with fewer risks

by Alexa Corker

As one of the most commonly diagnosed arrhythmias in the U.S., atrial fibrillation affects up to 6 million people in the country, and the National Institutes of Health estimates that by 2030, that number will have doubled to 12 million people.

Atrial fibrillation is an irregular heart rhythm that can cause uncomfortable symptoms like palpitations and shortness of breath and even worsen heart failure. Unfortunately, there is currently no cure for atrial fibrillation, but Rachel Kaplan, M.D., an electrophysiologist at MUSC, says that patients can still live a fulfilled life.

Previous procedures for treating atrial fibrillation had significant risks, but with the newer technique pulsed field ablation, or PFA, the risk of negative outcomes and collateral damage is lower.

“I think one of the things that is really helpful is that some of the scariest complications can now become rarer, and the procedure itself can become more efficient, which shortens the time a patient spends under anesthesia,” said Kaplan.

Historically, atrial fibrillation has been treated by conventional thermal ablation, which uses catheters that provide radiofrequency energy or freezing to destroy heart cells and cause tissue scarring. The irregular heartbeat signals are unable to pass through this scarred area of the heart, hopefully correcting the heartbeat rhythm. However, conventional thermal ablation also has risks, like damage to the nerves that control breathing and damage to the esophagus.

Kaplan calls PFA the new up-and-coming atrial fibrillation treatment procedure and was excited to have MUSC participate in a multi-center trial to compare the previous treatment to this one. The ADVENT study found PFA was comparable to thermal ablation and could even be more helpful since it boasts shorter procedure times and fewer adverse outcomes post-procedure.

PFA uses an energy source called electroporation, which occurs when electrical pulses break cell membranes in an area to cause cell damage and eventually lead to scar tissue. The energy used to create scar tissue in the heart has a much lower chance of damaging collateral structures compared to older technologies.

Kaplan is optimistic about the overall benefit this procedure will have on patients.

“PFA has less risk of damaging the esophagus, for instance, which can be a fatal complication,” she said.

As the use of PFA becomes more widespread, further advancement of the technique will only provide patients with higher quality care.

One draw for electrophysiologists like Kaplan is that MUSC has access to both of the currently available, FDA-approved and state-of-the-art catheters, so physicians can choose which catheter is best for their patient and their circumstances.

Kaplan says this reflects MUSC’s commitment and mission to innovation and excellence in patient care. “With the implementation of this new atrial fibrillation procedure, more patients will live a healthier and happier life.”