Electrical Field Energy
Pulsed Field Ablation (PFA)
Pulsed field ablation uses short bursts of electrical energy delivered through a catheter to treat selected heart tissue involved in an abnormal rhythm.
On this page
Understanding the technology
What Is PFA?
Pulsed field ablation (PFA) is a catheter-based treatment. Instead of heat or cold, it uses very short pulses of electrical energy to treat small areas of heart tissue.
The aim is to interrupt an abnormal electrical pathway or trigger. This page describes the energy source. For the overall procedure, see Catheter Ablation.
Pulsed field catheter, conceptual
The principle
How PFA Works
Pulses of electrical energy are delivered through electrodes on the catheter. The pulses create an electric field in the tissue that touches or lies close to the catheter.
The treated tissue no longer conducts electrical signals in the same way. The operator selects where and how the energy is applied, and the team monitors the electrical response.
Conceptual illustration of a pulsed electric field
The mechanism
Electroporation
The effect of PFA is described as electroporation. A strong electric field changes the cell membrane, which is the outer layer of the cell. With enough energy, this change affects how the cell works and the tissue stops conducting.
How tissues respond depends on the field strength, the pulse pattern and the type of tissue. Research on this topic continues, and the details differ between systems.
A common use
Pulmonary Vein Isolation
In atrial fibrillation, extra electrical activity often starts near the pulmonary veins. Pulmonary vein isolation aims to electrically separate these veins from the rest of the left atrium. PFA is one way to do this.
Whether this approach suits a person depends on the rhythm, the anatomy and the physician assessment. For the condition itself, see Atrial Fibrillation.
Delivery systems
Catheter Delivery
PFA catheters differ in shape. Some have a flexible tip with several electrodes, and others use a shape that is placed at the opening of a vein. The operator chooses a catheter according to the target.
Catheter shape
Different shapes suit different targets and anatomy.
Electrodes
Energy is delivered through electrodes at the catheter tip or along its shape.
Positioning
The catheter is guided to the target and checked for contact.
Energy settings
The system controls how the pulses are delivered.
Planning and guidance
Mapping and Guidance
Electrical mapping helps show where the rhythm starts and where treatment is needed. Imaging and electroanatomical systems may help guide the catheter. For more on this, see 3D Electroanatomical Mapping and the Electrophysiology Study.
Patient journey
Procedure Pathway
A general outline for a PFA procedure. The steps depend on the patient and the findings.
Assessment
Review of symptoms, history and tests.
Access
Catheters are introduced through a vein, usually in the groin.
Mapping
The team records the electrical activity.
Catheter placement
The PFA catheter is guided to the planned target.
Pulse delivery
Short pulses are delivered at the chosen sites.
Electrical check
Recordings show whether the target is isolated.
Recovery
Monitoring while the patient recovers.
Follow-up
A follow-up plan is explained.
Comparison
RF vs Cryo vs PFA
The three energy sources work in different ways. This is a comparison of mechanism only, not a ranking.
Energy source
Radiofrequency
Controlled thermal heating of a small area of tissue.
Energy source
Cryoablation
Controlled freezing of selected tissue.
This page
Pulsed field ablation
Short pulsed electrical fields applied to tissue.
The choice depends on the arrhythmia, the procedure plan and the individual patient.
Clinical context
Clinical Use
PFA may be considered for some patients, most often for pulmonary vein isolation in atrial fibrillation. Having one of these conditions does not mean PFA is needed.
Type of arrhythmia
Some rhythm problems suit one energy source better than another.
Treatment strategy
The plan may involve one or several targets.
Patient factors
Anatomy, other conditions and preferences are considered.
Physician assessment
The choice is made by the treating physician.
Available technology
Systems and catheters differ between centres.
Recovery and follow-up
Follow-up
After the procedure you are monitored while you recover. Follow-up depends on the rhythm treated and on how you are. It may include a review of symptoms and rhythm checks.
Seek urgent medical care for fainting, chest pain or severe breathlessness.
Questions
Frequently Asked Questions
What is pulsed field ablation?
What is electroporation?
Is PFA used for atrial fibrillation?
How is PFA different from RF and cryoablation?
Does everyone need PFA?
Is PFA available everywhere?
Is the treatment always successful?
What happens after the procedure?
Continue reading