Skip to main content
Log in

Pulsed Field Ablation: a New Paradigm for Catheter Ablation of Arrhythmias

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Current ablation approach for arrhythmias relies upon the use of radiofrequency (RF) and cryoablation catheters. Although there have been significant advances both in catheter design and in energy delivery approaches, limitations such as suboptimal efficacy and safety remain. Pulsed field ablation (PFA) has emerged as a novel approach to ablation that is distinct from RF and cryoablation by virtue of selective ablation of myocardial tissue. Preclinical and clinical reports have demonstrated lesion durability with an excellent safety profile. These findings need to be confirmed in prospective randomized trials that are currently ongoing. In this review, we describe efficacy and safety outcomes from both pre-clinical and clinical studies that have been performed so far and briefly discuss ongoing clinical trials and future investigations.

Recent Findings

Data from pre-clinical and clinical research have shown PFA as a promising tool for ablation of cardiac arrhythmias. In addition to safety regarding mitigating the risk to surrounding structures such as the phrenic nerve, esophagus, PFA also offers an effective method for ablation.

Summary

In this review, we summarize the currently published pre-clinical and clinical data evaluating the safety and efficacy of PFA for cardiac arrhythmias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

(Reproduced with permission from Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol 2019; 74: 315–326)

Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Muthalaly RG, John RM, Schaeffer B, et al. Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2018;29:854–60.

    Article  Google Scholar 

  2. Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality- clinical implications. Technol Cancer Res Treat. 2007;6:37–48.

    Article  Google Scholar 

  3. Prado LNS, Goulart JT, Zoccoler M, Oliviera PX. Ventricular myocyte injury by high-intensity electric field: effect of pulse duration. Gen Physiol Biophys. 2016;35:121–30.

    Article  CAS  Google Scholar 

  4. Nesin V, Bowman AM, Xiao S, et al. Cell permeabilization and inhibition of voltage-gated Ca ++ and Na+ channel currents by nanosecond pulsed electrical field. Bioelectromagnetics. 2012;33:394–404.

    Article  CAS  Google Scholar 

  5. Wittkampf FH, van Driel V, van Wessel H, et al. Feasibility of electroporation for the creation of pulmonary vein ostial lesions. J Cardiovasc Electrophysiol. 2011;22:302–9.

    Article  Google Scholar 

  6. Koruth JS, Kuroki K, Enomoto Y, et al. Electrophysiological and histological assessment of thoracic vein isolation: preclinical evaluation of pulsed field ablation. Circ Arrhythm Electrophysiol. 2019;12:e007781.

  7. Yavin H, Shapira-Daniels A, Barkagan M, et al. Pulsed-field ablation using a lattice electrode for focal energy delivery: biophysical characterization, lesion durability and safety evaluation. Circ Arrhythm Electrophysiol. 2020;13:e008580.

  8. Wittkampf FH, van Direl VJ, van Wessel H, et al. Myocardial lesion depth with circular electroporation ablation. Circ Arrhythm Electrophysiol. 2012;5:581–6.

    Article  Google Scholar 

  9. du Pre’ BC, van Driel V, van Wessel H, et al. Minimal coronary artery damage by myocardial electroporation ablation. Europace. 2013;15:144–9.

  10. Koruth JS, Kuroki K, Iwasawa J, et al. Endocardial ventricular pulsed field ablation: a proof-of-concept preclinical evaluation. Europace. 2020;22:434–9.

    Article  Google Scholar 

  11. Reddy VY, Koruth J, Jais P, et al. Ablation of atrial fibrillation with pulsed electrical fields: an ultra-rapid, tissue-selective modality for cardiac ablation. J Am Cardiol EP. 2018;987–95.

  12. Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019;74:315–26.

    Article  Google Scholar 

  13. • Reddy VY, Dukkipati SR, Neuzil P, et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT-II. JACC Clin Electrophysiol. 2021;5:614–27. Study on pooled analyses of the contemporary clinical trials which demonstrated durability of PV lesion sets and long term clinical outcomes.

  14. • Reddy VY, Anic A, Koruth J, et al. Pulsed field ablation in patients with persistent atrial fibrillation. J Am Coll Cardiol. 2020;76:1068–80. Clinical study that described the clinical outcomes of PFA in patients who had persistent AF.

  15. Reddy VY, Anter E, Rackauskas G, et al. Lattice-tip focal ablation catheter that toggles between radiofrequency and pulsed field energy to treat atrial fibrillation: a first-in-human trial. Circ Arrhythm Electrophysiol. 2020;13:e008718.

  16. Stewart MT, Haines DE, Verma A, et al. Intracardiac pulse field ablation: proof of feasibility in a chronic porcine model. Heart Rhythm. 2019;16:754–64.

    Article  Google Scholar 

  17. Van Driel V, Neven K, Van Wessel H, et al. Pulmonary vein stenosis after catheter ablation: electroporation versus radiofrequency. Circ Arrhythm Electrophysiol. 2014;7:734–8.

    Article  Google Scholar 

  18. Kuroki K, Whang W, Eggert C, et al. Ostial dimensional changes after pulmonary vein isolation: Pulsed field ablation vs. radiofrequency ablation. Heart Rhythm 2020;17:1528–35.

  19. Neven K, van Driel V, van Wessel H, et al. Myocardial lesion size after epicardial electroporation catheter ablation after subxiphoid puncture. Circ Arrhythm Electrophysiol. 2014;7:728–33.

    Article  Google Scholar 

  20. Neven K, van Es R, van Driel V, et al. Acute and long-term effects of full power electroporation ablation directly onto the porcine esophagus. Circ Arrhythm Electrophysiol. 2017;10:e004672.

  21. • Koruth JS, Kuroki K, Kawamura I, et al. Pulses field ablation versus radiofrequency ablation: esophageal injury in a porcine model. Circ Arrhythm Electrophysiol. 2020;13:e00803. Findings from this study highlight the pre-clinical data on safety of PFA in esophageal tissue.

  22. Lee BK, Choi KJ, Kim J, et al. Right phrenic nerve injury following electrical disconnection of the right superior pulmonary vein. Pacing Clin Electrophysiol. 2004;27:1444–6.

    Article  Google Scholar 

  23. Schmidt B, Chun KR, Ouyang F, et al. Three-dimesional reconstruction of the anatomic course of the right phrenic nerve in humans by pace mapping. Heart Rhythm. 2008;5:1120–6.

    Article  Google Scholar 

  24. Roka A, Heist EK, Refaat M, et al. Novel technique to prevent phrenic nerve injury during pulmonary vein isolation using pre-procedural imaging. J Cardiovasc Electrophysiol. 2015;10:1057–62.

    Article  Google Scholar 

  25. Van Driel V, Neven K, Van Wessel H, et al. Low vulnerability of right phrenic nerve to electroporation ablation. Heart Rhythm. 2015;12:1838–44.

    Article  Google Scholar 

  26. du Pre BC, van Driel VJ, van Wessel H, et al. Minimal coronary artery damage by myocardial electroporation ablation. Europace. 2013;15:144–9.

    Article  Google Scholar 

  27. Gunawardene MA, Schaeffer BN, Jularic M, et al. Coronary spasm during pulsed field ablation of the mitral isthmus line. JACC Clin Electrophysiol. 2021 (article in press), PMID:34600850.

  28. https://clinicaltrials.gov/ct2/show/NCT04198701 (Last accessed 02  Jan 2021).

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Abhishek Maan.

Ethics declarations

Conflict of Interest

AM: research grants, Medtronic, Biotronik, Biosense-Webster; research equipment support, QT medical, Bardy Rx; equity, Proteostasis Inc, NovaVax, MyoKardia, Acutus Inc. JK: consultant, Farapulse; consultant, equity, Affera.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Invasive Electrophysiology and Pacing

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maan, A., Koruth, J. Pulsed Field Ablation: a New Paradigm for Catheter Ablation of Arrhythmias. Curr Cardiol Rep 24, 103–108 (2022). https://doi.org/10.1007/s11886-021-01630-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-021-01630-z

Keywords

Navigation