Treating AFib With Pulsed Field Ablation

While the areas of the heart targeted during ablative procedures have remained largely unchanged over the years, the energy sources used to treat abnormal heart rhythms have evolved. “Radiofrequency (RF) energy, which uses heat, was the gold standard for more than two decades. Cryoablation, which uses freezing, became another important treatment option more than a decade ago. The newest technology is pulsed field ablation (PFA), which we have been using at AdventHealth for more than two years,” explained Dr. Mondal.

Unlike traditional RF and cryoablation, PFA is mostly a nonthermal technology that uses short, high-voltage electrical pulses to create tiny pores within the membranes of targeted heart cells. “This process, called electroporation, disrupts the cells and causes the abnormal tissues responsible for maintaining the heart rhythm disturbance to become electrically inactive,” said Dr. Mondal. PFA effectively targets cardiac tissue while minimizing the amount of heat or freezing delivered to surrounding structures. This may help reduce the risk of injury to nearby structures, like the esophagus, phrenic nerve and vagal nerves.

The Affera™ mapping and ablation system is an advanced pulsed field ablation platform used by our cardiac electrophysiologists that features the Sphere-9 catheter. One of its key advantages is that the catheter can perform high-density electroanatomical mapping of the heart while also delivering ablation therapy,” explained Dr. Mondal. In other words, the Affera system allows our physicians to both map and treat abnormal electrical activity in the heart using the same catheter.

Another benefit of the Affera PFA system is that it’s a dual-energy platform. “The Sphere-9 catheter can deliver both radiofrequency energy and pulsed field energy, giving us the flexibility to choose which energy source is most appropriate for each patient,” said Dr. Mondal. Having both energy sources available allows our providers to individualize every procedure and potentially improve safety and effectiveness.

The Affera PFA system benefits patients by using a relatively slim catheter and delivery sheath, which may help to reduce complications at the vascular access point. This system also makes the procedure easier for electrophysiologists because the Sphere-9 catheter has a similar design and handling characteristics to conventional RF catheters, making it easier for physicians to adapt to this technology.

“As with any ablation system, Affera has potential risks, including bleeding or vascular complications, cardiac perforation, arrhythmia and other complications associated with catheter ablation,” shared Dr. Mondal. It’s important to know that the choice of technology and energy source used should be tailored to each patient’s anatomy for optimal results.

Pulsed field ablation can be used to treat most patients having a catheter ablation procedure for both atrial fibrillation and atrial flutter. PFA can be effectively used to treat arrhythmias in both the left and right atria, making it a versatile tool for a wide range of atrial arrhythmias. However, there isn’t a single catheter that’s suited for every situation.

The Affera system has substantial clinical experience and regulatory approval for use in atrial fibrillation and other atrial arrhythmias. However, there’s currently limited experience and clinical data regarding the Affera system’s treatment of ventricular arrhythmias. Because of this, Dr. Mondal shared that the choice of catheter and ablation technology should be based on each patient’s specific arrhythmia, its location and their individual anatomy.

PFA can be considered for most patients with AFib. However, several factors must be considered, including the type and duration of the patient’s AFib, symptoms, heart anatomy and function, prior treatments and their overall health.

“Pulsed field ablation has demonstrated strong results in the treatment of atrial fibrillation, to reduce or eliminate episodes of AFib and improve patients' quality of life. As with any AFib ablation, outcomes can vary depending on the type and duration of AFib, the patient's underlying heart condition and other individual factors,” shared Dr. Mondal. It’s important to note that some patients may require additional treatment or repeat ablation procedures over time.

For most patients, recovery from PFA is short, with many returning home the same day. “Patients are advised to avoid heavy lifting and strenuous exercise for one week, followed by a gradual return to normal activities once cleared by their physician,” said Dr. Mondal. “The relatively small delivery sheaths used may also contribute to patient comfort and recovery while reducing complications related to vascular access.” Be sure to discuss your specific post-procedure instructions with your physician to ensure a smoother recovery.