What is Pulsed Field Ablation (PFA)? – The principle of electroporation Pulsed Field Ablation is based on the biophysical principle of irreversible electroporation. Strong electric fields are delivered via a special catheter for fractions of a second (in the nanosecond range). These fields create tiny pores in the cell membrane of the heart muscle cells (cardiomyocytes). These pores disrupt the cell’s equilibrium, causing the cell to die (apoptosis) without resulting in extensive tissue damage from burns. The treated area heals in a controlled manner and no longer transmits electrical interference signals – thus ending atrial fibrillation.
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In Pulsed Field Ablation (PFA), electric fields create tiny pores in the heart cells to stop atrial fibrillation without generating heat.
Difference from radiofrequency and cryoablation Previous standard procedures in electrophysiology are thermal:
- Radiofrequency ablation: Heats the tissue (“cooking”).
- Cryoablation: Freezes the tissue (cryogenisation).
Both methods are very effective, but carry a small risk that the temperature may also damage surrounding tissue (e.g. the esophagus, which lies directly behind the heart). Pulsed Field Ablation is non-thermal. As different types of tissue (heart muscle, nerves, blood vessels) react differently to electric fields, the cardiologist can adjust the energy so that only the heart muscle cells are affected. Nerves and blood vessels remain intact.
Procedure for PFA treatment in the cardiac catheterization laboratory The procedure is similar to that of a standard EP (electrophysiological study):
- Access: Under local anesthesia and sedation (twilight sleep), the doctor guides the PFA catheter via the femoral vein into the left atrium of the heart.
- Mapping & positioning: Using 3D mapping or X-ray guidance, the catheter is positioned at the openings of the pulmonary veins (the most common trigger for atrial fibrillation).
- Ablation: The electrical pulses are delivered within a few seconds. The procedure known as pulmonary vein isolation (PVI) is often completed in a matter of minutes.
- Check: The doctor immediately checks whether the disruptive signals have been blocked.
Advantages and safety: Why PFA is considered a revolution Pulsed Field Ablation offers decisive advantages in cardiology:
- Maximum safety: The risk of injury to the phrenic nerve (phrenic nerve palsy) or the esophagus is virtually eliminated.
- Speed: The actual ablation time is extremely short. The entire procedure often takes significantly less than an hour.
- Effectiveness: Studies show that the isolation of the pulmonary veins is very long-lasting, which prevents recurrence of cardiac arrhythmias.
Who is pulsed field ablation suitable for? The method is primarily suitable for patients with symptomatic, paroxysmal or persistent atrial fibrillation in whom medication is not sufficiently effective. Whether PFA is preferable to conventional procedures in an individual case is determined by the electrophysiologist based on the patient’s anatomical conditions.
Is pulsed field ablation painful? As the procedure is carried out under sedation (twilight sleep) or short-term anesthesia, the patient feels nothing. As no heat is generated, many patients also report less chest pain after the procedure than with thermal methods.
How long does the PFA procedure take? The procedure is very efficient. While conventional ablations often take 1–2 hours or longer, a PFA treatment can often be completed in under 60 minutes.
Are there any long-term effects associated with electroporation? As the procedure is still relatively new, long-term studies are currently underway. However, data collected over several years to date show no negative long-term effects, but rather confirm the high safety of this tissue-specific approach.
Does the health insurance cover the new method? Yes, Pulsed Field Ablation is an approved procedure and is covered by health insurance providers where indicated. It is primarily offered in specialist cardiac centers and university hospitals.
