Pearls and Pitfalls of Pulsed Field Ablation

Abstract

Author's summary Pulsed field ablation (PFA) is a fast advancing technology in the interventional treatment of cardiac arrhythmias that utilizes the phenomenon of irreversible electroporation as a non-thermal energy source. Pre-clinical and first clinical studies suggest that PFA could overcome the main limitations of current standard of care energy sources and improve the efficacy and safety profile of cardiac catheter ablation. This review provides an overview of the current knowledge on PFA and discusses “pearls” and potential “pitfalls” of the technology.

Wide Antral Circumferential Re-Ablation for Recurrent Atrial Fibrillation after Prior Pulmonary Vein Isolation Guided by High-Density Mapping Increases Freedom from Atrial Arrhythmias

“…Our findings highlight the importance of HDM and its technical advantages over conventional mapping for the detection of arrhythmogenic foci in terms of inhomogenity or even non-transmurality within the initial lesion set, and the superior clinical outcome of the Re-WACA strategy emphasizes the arrhythmogenic potential of the PV antral area in general. The clinical relevance of our data is high, since redo procedures after PVI using single shot technologies such as cryoballoon ablation and pulsed field ablation [45] will dramatically increase with the inherent need for deployment of more antral lesions. Future implementation of artificial intelligence could optimize ablation strategies and improve outcome further [46].…”

Pulsed field ablation through an atrial shunt device

“…Ablation would involve the left atrium with concern as to how the Corvia would interact with the electrophysiology wires, catheters, sheaths, and ablation. The primary concerns were as follows: (1) electrophysiology catheters getting caught on an exposed part of the Corvia on either side of the septum that had not been endothelialized; (2) the shunt diameter being too narrow to cross with a sheath owing to endothelialization (the Corvia has an 8 mm shunt diameter 1 and the Farawave sheath that crosses the atrial septum has an outer diameter of 16.8F, which equates to 5.6 mm 2 ) (3) the safety of ablating tissue close to or on the Corvia in relation to its nitinol material; (4) performing a transseptal puncture in a septum with a Corvia in situ.…”

Redo procedures after sinus node sparing hybrid ablation for inappropriate sinus tachycardia/postural orthostatic sinus tachycardia

“…This system has been demonstrated to deliver lesions up to 8.2 mm in depth, providing a rationale for its clinical efficacy in IST redo ablation. 22 , 23 …”