Pulsed Field Ablation: A New, Safer Treatment for Atrial Fibrillation.

A new technology available at MedStar Washington Hospital Center called pulsed field ablation (PFA) offers a treatment option for atrial fibrillation (AFib) that reduces the risk of complications.

The U.S. Centers for Disease Control and Prevention estimates that 12.1 million people in the U.S. will have AFib by 2030. The most common type of arrhythmia, AFib happens in the heart’s upper chambers. It makes the heart beat irregularly due to electrical malfunction, reducing blood flow and increasing your risk of stroke and heart failure. 

For the last 25 years, cardiac electrophysiologists at MedStar Heart &  Vascular Institute and beyond have used ablation procedures to treat AFib when medications don’t help. Procedures like these treat the tissue causing AFib symptoms by making cardiac cells electrically inert:

• Radio frequency ablation uses heat to cauterize (burn) cells around the pulmonary vein that trigger AFib. 
• Cryoablation uses extreme cold to achieve the same goal. 

Standard ablation procedures can carry a risk of complications including bleeding, perforation, and damage to the esophagus, phrenic nerve, blood vessels, and/or heart valves. 

But if radio frequency ablation and cryoablation are like an early cell phone that could only call or text, PFA is like an iPhone 15. The FARAPULSE™ PFA system, which was approved by the U.S. Food and Drug Administration in January 2024, uses a new kind of energy to make the cells causing AFib inactive rather than to destroy them. 

MedStar Health cardiac electrophysiologists performed the first FARAPULSE™ pulsed field ablation procedure in the region at MedStar Washington Hospital Center on April 22, 2024. To date, our research and clinical experience with PFA has shown a significant reduction in complications and no reported cases of injuries to the phrenic nerve, which controls the diaphragm and is essential to breathing.

How pulsed field ablation works.

The cardiac electrophysiologist threads a thin tube called a catheter through a patient’s veins from the groin to the upper chamber of the heart. There, the instrument releases electromagnetic waves into the cardiac tissue responsible for AFib. By a process called electroporation, the waves make microscopic holes in the cell membranes so electrical impulses can’t go astray and cause AFib. 

Patients usually rest in the hospital for a few hours after the procedure and return home the same day. Over the next few months, patients stop taking medications for AFib. Depending upon their individual risk factors, some patients remain on blood thinners. Our goal is to minimize long-term medication use for our patients and reduce AFib symptoms, such as:

• Chest pain
• Fatigue
• Heart palpitations that can feel rapid, fluttery, or pounding
• Irregular heartbeat
• Lightheadedness
• Shortness of breath

The best candidates for pulsed field ablation are patients whose AFib is in the paroxysmal or early persistent states:

• Paroxysmal atrial fibrillation: A brief event of fibrillation that lasts less than a week.
• Persistent atrial fibrillation: When irregular heart rhythms last more than a week.

Without treatment, AFib can progress and become more challenging to treat. For most patients who are candidates, pulsed field ablation offers the safest option. For longstanding persistent or permanent AFib, the overall success rate of pulsed field ablation is lower. Surgical ablation may be a better option in some cases.

Our research in pulsed field ablation.

Medstar Washington Hospital Center stays at the forefront of technology and brings advances to our patients faster through clinical trials. Our researchers have been working with pulsed field ablation for several years, becoming experts in the technology before it was available to the general public.

Some of our studies that have helped make pulsed field ablation a reality for patients include:

• The PULSED AF pivotal study: This global study used PFA to treat 300 patients with paroxysmal or persistent AFib. Our results showed PFA was effective at one year in 66.2% of patients with paroxysmal AFib and 55.1% of patients with persistent AFib. We also showed that PFA is safe for patients.
• The ADVENT Trial: This 12-month randomized clinical trial of the FARAPULSE™ PFA system tested the safety and effectiveness of PFA compared to other ablation procedures to treat paroxysmal AFib. Our research showed the system helps more people with AFib stay off medications with a low risk of complications.
• The AdmIMRE Study: Results from this pilot study showed that 80% of patients treated with pulsed field ablation using the VARIPULSE™ platform were AFib recurrence-free after one year and reported no complications.