Patients with atrial fibrillation (AFib) may benefit from a new procedure known as pulsed field ablation (PFA).
AFib is the most common abnormal heart rhythm, affecting millions of Americans. It can cause an irregular heartbeat and other cardiovascular symptoms. Pulsed field ablation is a minimally invasive catheter-based procedure that delivers electrical pulses to kill the cells that are causing AFib.
Unlike other catheter ablation procedures, PFA specifically targets the cells causing AFib. It can cause less damage to surrounding tissue, allowing patients to achieve a normal heart rhythm with less risk of complications.
The U.S. Food and Drug Administration (FDA) has approved multiple PFA devices to treat AFib.
At a leading cardiovascular center like the UPMC Heart and Vascular Institute, patients can expect excellent results from PFA.
Pulsed field ablation (PFA) is a new, minimally invasive treatment option for atrial fibrillation (AFib), the most common abnormal heart rhythm.
PFA uses short bursts of electrical energy delivered through a specially designed catheter to target and destroy the specific heart tissue causing the irregular heartbeat. The short pulses of high-energy electricity create small holes in the cell membrane of the targeted tissue, leading to cell death.
Traditional catheter ablation techniques use thermal energy — either extreme heat or extreme cold — to kill the cells that cause Afib. Although these methods are effective, they have been associated with a small risk of damage to tissues surrounding the heart.
The electrical pulses used in PFA are more specifically targeted. There is a lower risk of damaging nearby structures like the esophagus and phrenic nerve than traditional catheter ablation. Clinical trials also show promising results from PFA, with high success rates in treating AFib.
PFA procedures also may be faster than traditional ablation methods, leading to quicker recovery times.
You may need pulsed field ablation if you have AFib. As a treatment, PFA can help restore normal heart rhythm in people with AFib.
AFib is a condition that occurs when the atria — the upper chambers of your heart — beat irregularly. The abnormal beats often originate in the pulmonary veins, which connect the heart to the lungs. These abnormal beats are carried into the left atria, leading to AFib.
AFib can cause symptoms like:
Over time, AFib can weaken your heart and increase your risk for heart failure and other problems. It also is associated with a risk of blood clots and stroke.
The goal of pulsed field ablation is to kill the cells that are causing AFib. It has the potential to give patients a normal heart rhythm, allowing for a better quality of life.
You may be a candidate for pulse field ablation if:
Pulsed field ablation is a safe and effective procedure when an experienced electrophysiologist performs the procedure.
However, there are risks associated with any medical procedure. Like other catheter ablation techniques, PFA carries a small risk of:
Your doctor will explain the pulsed field ablation procedure to you and give you a chance to ask questions.
To prepare for pulsed field ablation, you should:
On the day of the procedure, wear comfortable clothing and bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.
Most patients can go home on the same day as the procedure, but some patients may need to stay overnight. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home after your discharge.
The length of the procedure can vary depending on factors like the size of your heart chambers and your specific type of AFib. However, most PFA procedures last between one and two hours. This timeframe makes PFA significantly faster than other thermal ablation techniques.
Before your procedure, you will see an anesthesiologist who will monitor you and keep you comfortable during the procedure. Most patients receive general anesthesia and will have a tube to help them breathe. You will receive IV medications and will be asleep during the procedure.
A specialist called an electrophysiologist performs the procedure. Using a small incision in the groin, they will insert a catheter up through a vein leading to the heart and into the heart’s top left chamber. They will use imaging technology, including x-ray, ultrasound, and 3D mapping, for guidance.
The electrophysiologist will position the catheter around the target tissues in the left atrium. They will then deliver short bursts of electrical energy to the target area to eliminate the source of irregular heartbeats.
The energy level of the electrical pulses is too high for the targeted cells to withstand. The electrical pulses create holes in the cell membranes, which eventually leads to those cells dying.
After your procedure, you will be taken to the recovery unit. Most patients regain consciousness within 30 minutes as the anesthesia wears off. Most people have no memory of the procedure. You can have visitors at your bedside once you are awake.
Patients should stay in bed for two to four hours after their procedure to allow the incisions in their groin to heal. After four hours, your care team will ask you to take a walk in the recovery unit. If you are stable, you will be discharged home that same day.
A small number of patients will need to stay overnight for observation. These patients typically can go home the following morning.
Before discharge, your doctor and nurse will review your medications to determine if any changes or new medications are needed.
You will need to have someone to transport you home after your discharge.
You should be able to return to your normal routine one week after your procedure. You should avoid heavy lifting and strenuous activities for one week.
Ask your doctor when you can return to work. Patients whose jobs require strenuous activity and/or heavy lifting may need more time to return to work.
Your doctor may tell you to avoid driving for a certain length of time after your procedure. You should follow their instructions to have your best outcome.
You will have regular follow-ups with your doctor to assess the treatment's effectiveness and your overall health. It is very important that you see your doctor for follow-up visits as recommended.
The risk of complications from pulsed field ablation is low. But you should call your doctor if you experience any unusual symptoms, including:
Call 911 or visit the nearest emergency department immediately if any of these symptoms are severe.
Most people’s heart rhythms return to normal after pulsed field ablation. However, some may still need to take their heart rhythm medications. A small number of people may need to have another AFib procedure in the future if their abnormal heart rhythm returns.
The success of catheter ablation depends on several factors, including how long a patient has had AFib and other medical risk factors.
Clinical trials evaluating PFA reported that PFA eliminated symptoms of AFib in more than 80% of patients without needing medications.
The UPMC Heart and Vascular Institute is one of the leading centers for cardiovascular care in the United States. Our experts have many years of experience in diagnosing and treating a wide range of conditions, from common to complex.
At UPMC, we are always working to introduce new innovative technologies that will meaningfully benefit our patients.
Experts at UPMC have extensive experience with pulsed field ablation technology. We were the first team in Pennsylvania to participate in a national clinical trial to evaluate the safety and effectiveness of the PFA system. We are excited to offer this treatment to patients with AFib.
