Pulsed Field Ablation: What We Do and Do Not Know

Dear Readers,

For many in our field, PFA stands for “Pretty Freaking Awesome.” A PubMed search for pulsed field ablation (PFA) gives a result of 899 total publications with logarithmic growth over time, but much of the research is related to noncardiac therapies, including cancer treatment. A PubMed search for “PFA” plus “cardiac” yields similarly logarithmic growth in publications, but only 282 papers. What do we actually know and not know in 2022 about PFA as an energy source for ablation of atrial fibrillation (AF)? The table here provides a summary.

We know a lot about the use of catheter ablation for AF using PFA, but as more information is obtained, more questions will arise. For example, there is much data that PFA is more selective for cardiac tissue than nerves. A recent in vitro study, however, showed that neurons exhibit higher susceptibility to electroporation and cell death at higher field strength of 1250 V/cm in comparison to cardiomyocytes.¹ It will take a lot more time before we fully appreciate the role of PFA in cardiac electrophysiology. 

Bradley P. Knight, MD, FACC, FHRS

@DrBradleyKnight
Editor-in-Chief, EP Lab Digest

Disclosures: Dr Knight reports that he has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Medtronic, Philips, and Sanofi. He has no equity or ownership in any of these companies.

Reference

1. Avazzadeh S, Dehkordi MH, Owens P, et al. Establishing electroporation thresholds for targeted cell specific cardiac ablation in a 2D culture model. J Cardiovasc Electrophysiol. Published online August 4, 2022. doi:10.1111/jce.15641