Pulsed field ablation
Pulsed field ablation (PFA) is a non-thermal (not using extreme heat or cold) method of biological ablation (removal of structure or functionality) utilizing high-amplitude pulsed (microsecond duration) electric fields to create irreversible electroporation in tissues.[1] [2] It is used most widely to treat tumors (cancer) or cardiac arrhythmias.[3]
Background
[edit]Atrial fibrillation frequently results from bursts of tachycardia that originate in muscle bundles extending from the atrium to the pulmonary veins.[4] Pulmonary vein isolation ablation technology has used thermal methods (radiofrequency ablation or, less often, cryoablation) to destroy pulmonary vein cells.[5] As with thermal methods of ablation, in pulsed field ablation, a thin, flexible tube (catheter) is inserted into a blood vessel in the groin and threaded up into the heart to ablate the areas of the pulmonary vein causing excessively rapid electrical signals.[6]
Advantages
[edit]A major reason for recurrence of atrial fibrillation after ablation has been the belief of electrical pulmonary vein reconnection, which has not been seen for PFA.[7] In one study, atrial fibrillation recurrence in the thermal ablation group was 39% compared to 11% in the PFA group.[8] PFA can achieve pulmonary vein isolation faster than other ablation methods.[1][8] Compared to radiofrequency ablation, PFA produces lesions of greater uniformity.[5]
Safety
[edit]Cell death following PFA is usually due to apoptosis, which is a far less damaging and inflammatory form of cell death than necrosis.[1][3] In contrast to thermal methods of ablation, PFA specifically kills cardiomyocytes (cardiac muscle cells) without injuring surrounding tissues.[1][2] Thermal ablation methods can damage the esophagus, phrenic nerve, and coronary vessels (as high as 5% [8]), which are spared by PFA.[1] One study showed an overall complication rate of 0.7% for PFA and no occurrence of phrenic nerve, esophageal, or pulmonary vein injury.[9]
Challenges
[edit]Because PFA is a relatively newer ablation technique, there is a lack of uniformity in the parameters for its delivery.[8] Better standardization could help reduce instances of coronary artery spasm and pulmonary artery hemorrhage, which can occur.[8] The equipment cost and lack of specialized training have limited the widespread use of PFA, making it unavailable to many patients.[8]
References
[edit]- ^ a b c d e Bradley CJ, Haines DE (2020). "Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation". Journal of Cardiovascular Electrophysiology. 31 (8): 2136–2147. doi:10.1111/jce.14414. PMID 32107812.
- ^ a b Schaack D, Schmidt B, Chun KJ (2023). "Pulsed Field Ablation for Atrial Fibrillation". Arrhythmia & Electrophysiology Review. 12: e11. doi:10.15420/aer.2022.45. PMC 10326665. PMID 37427302.
- ^ a b Napotnik TB, Polajžer T, Miklavčič D (2021). "Cell death due to electroporation - A review". Bioelectrochemistry. 141: 107871. doi:10.1016/j.bioelechem.2021.107871. PMID 34147013.
- ^ McGarry TJ, Narayan SM (2012). "The anatomical basis of pulmonary vein reconnection after ablation for atrial fibrillation: wounds that never felt a scar?". Journal of the American College of Cardiology. 50 (10): 939–941. doi:10.1016/j.jacc.2011.11.032. PMC 3393092. PMID 22381430.
- ^ a b Matos CD, Hoyos C, Osorio J (2023). "Pulsed Field Ablation of Atrial Fibrillation: A Comprehensive Review". Reviews in Cardiovascular Medicine. 24 (11): 337. doi:10.31083/j.rcm2411337. PMC 11272841. PMID 39076426.
- ^ Ames A, Stevenson WG (206). "Catheter ablation of atrial fibrillation". Circulation. 113 (13): e666-8. doi:10.1161/CIRCULATIONAHA.105.613083. PMID 16585395.
- ^ Reddy VY, Neuzil P, Jais P (2019). "Pulsed Field Ablation for Pulmonary Vein Isolation in Atrial Fibrillation". Journal of the American College of Cardiology. 74 (3): 15–326. doi:10.1016/j.jacc.2019.04.021. PMID 31085321.
- ^ a b c d e f Iyengar SK, Iyengar S, Srivathsan K (2023). "The promise of pulsed field ablation and the challenges ahead". Frontiers in Cardiovascular Medicine. 10: 1235317. doi:10.3389/fcvm.2023.1235317. PMC 10627215. PMID 37937293.
- ^ Verma A, Haines DE, DeLurgio DB (2023). "Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial". Circulation. 147 (19): 422–1432. doi:10.1161/CIRCULATIONAHA.123.063988. PMC 10158608. PMID 36877118.
External links
[edit]- Cardiac Ablations for Atrial Fibrillation: What to Expect After Your Procedure on Massachusetts General Hospital
- Focal Pulsed Field Ablation Guided by Contact & Noncontact Mapping on AF Symposium 2022