Pulsed field ablation – Electroporation

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia and pulmonary vein isolation (PVI) is the primary treatment. PVI is the most common electrophysiological intervention and therefore safety and efficacy are essential. PVI has so far been performed with thermal energy sources (cryo- or radiofrequency ablation). Pulsed field ablation (PFA) is a new ablation technique using non-thermal energy, which is tissue selective, i.e. they only induce cell death in the myocardium. The preclinical studies address the safety of creating a PFA lesion, demonstrating by histological images the selective ablation of the myocardium whilst preserving the intact structure of the surrounding tissue. Clinical studies have investigated the long-term efficacy of PVIs performed using different systems and their associated catheters. The follow-up methods used in clinical trials have not been uniform, with some clinical trials even involving invasive left atrial remapping. In others, only clinical, i.e. symptom or complaint-oriented follow-up was chosen, supplemented with non-invasive tests (ECG at a specific time or Holter ECG) to obtain the rate of arrhythmia-free follow-up.

Keywords

• catheter ablation
• pulsed field ablation
• electroporation