International Journal of Frontiers in Medicine, 2024, 6(9); doi: 10.25236/IJFM.2024.060901.
Baoping Li1, Tingting Zhao2
1Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Heze Hospital of Traditional Chinese Medicine, Heze, China
2Heze Peony People's Hospital, Heze, China
Atrial fibrillation (AF) is a common cardiac arrhythmia that poses significant health risks and impairs quality of life for affected patients. Traditional treatment methods, such as radiofrequency ablation, have limitations. In recent years, Pulsed field ablation (PFA) has emerged as a new therapeutic option and has attracted widespread research interest. The review aims to evaluate the potential and efficacy of PFA as a treatment for AF. Compared to traditional ablation methods, PFA offers lower risk of complications and less thermal damage to surrounding tissues. However, further studies are needed to verify its long-term efficacy and superiority. Additionally, personalized treatment strategies, technological advancements, and broader clinical applications are important areas for future investigation.
Atrial fibrillation; Pulsed field ablation; Thermal ablation; Safety; Non-thermal therapy
Baoping Li, Tingting Zhao. Pulsed Field Ablation as a New Option for the Treatment of Atrial Fibrillation. International Journal of Frontiers in Medicine (2024), Vol. 6, Issue 9: 1-6. https://doi.org/10.25236/IJFM.2024.060901.
[1] Tondo C. How the new technologies and tools will change the electrophysiology of the future. Eur Heart J Suppl. 2023;25(Suppl C):C249-C252.
[2] Hindricks G, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS). Eur Heart J. 2021;42(5):373–498
[3] Kornej J, Borschel C, Benjamin E, Schnabel R. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ. Res. 2020; 127, 4–20.
[4] Kirchhof P, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–2962.
[5] Chen L. Y, and Shen WK.Epidemiology of atrial fibrillation: Acurrent perspective. Heart rhythm. 2007; 4 (3), S1–S6.
[6] Tini G, Scagliola R, Monacelli F, La Malfa G, Porto I, Brunelli C, Ros G.M. Alzheimers Disease and Cardiovascular Disease: A Particular Association. Cardiol. Res. Pract. 2020; 2020, 2617970.
[7] Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: A population-based study. ACC Curr. J. Rev. 2004; 164, 1675–1678.
[8] Chamberlain A.M, Agarwal S.K, Folsom A.R, Duval S, Soliman E.Z, Ambrose M, Eberly L, Alonso A. Smoking and incidence of atrial fibrillation: Results from the Atherosclerosis Risk in Communities (ARIC) Study. Hear. Rhythm. 2011;8, 1160–1166.
[9] Casciola M, Feaster TK, Caiola MJ, Keck D, Blinova K. Human in vitro assay for irreversible electroporation cardiac ablation. Front Physiol. 2023;13:1064168.
[10] Metzner A, Kuck KH, Chun JKR. What we have learned: is pulmonary vein isolation still the cornerstone of atrial fibrillation ablation? Europace. 2022; 24(Suppl 2):ii8-ii13.
[11] Patterson E, Po SS, Scherlag BJ, Lazzara R. Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation. Heart Rhythm. 2005; 2, 624–631.
[12] Avazzadeh S, O'Brien B, Coffey K, O'Halloran M, Keane D, Quinlan LR. Establishing Irreversible Electroporation Electric Field Potential Threshold in A Suspension In Vitro Model for Cardiac and Neuronal Cells. J Clin Med. 2021 ;10(22):5443.
[13] Aldaas OM, Malladi C, Aldaas AM, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions. Heart Rhythm O2. 2023;4(10):599-608.
[14] Stewart MT, et al. Intracardiac pulsed field ablation: proof of feasibility in a chronic porcine model. Heart Rhythm. 2019;16(5):754–764.
[15] Xie F, Zemlin CW. Effect of Twisted Fiber Anisotropy in Cardiac Tissue on Ablation with Pulsed Electric Fields. PLoS One. 2016;11(4):e0152262.
[16] Kotb A, Chin SH, Ng GA. Recent advances in the tools available for atrial fibrillation ablation. Expert Rev Med Devices. 2022;19(2):141-154.
[17] Ruzgys P, Novickij V, Novickij J, Šatkauskas S. Influence of the electrode material on ROS generation and electroporation efficiency in low and high frequency nanosecond pulse range. Bioelectrochemistry. 2019;127:87-93.
[18] Munawar T, Fujimori M, Vista W, Solomon S, Srimathveeravalli G. Abstract No. 368 Changes in ph and not temperature significantly contributes to cell death during IRE performed at low-voltage and high pulse numbers. J Vasc Interv Radiol. 2019; 30: S162-S163.
[19] Rubinsky L, Guenther E, Mikus P, Stehling M, Rubinsky B. Electrolytic effects during tissue ablation by electroporation. Technol Cancer Res Treat. 2016;15:NP95-NP103.
[20] Xie F, Varghese F, Pakhomov AG, Semenov I, Xiao S, Philpott J, Zemlin C. Ablation of myocardial tissue with nanosecond pulsed electric fields. PLoS One. 2015;10:e0144833.
[21] Zhang H, Liu K, Xue Z, Yin H, Dong H, Jin W, et al. High-voltage pulsed electric field plus photodynamic therapy kills breast cancer cells by triggering apoptosis. Am J Transl Res. 2018; 10: 334–51
[22] Howard B, Haines DE, Verma A, Packer D, Kirchhof N, Barka N, Onal B, Fraasch S, Miklav D, Stewart M.T.Reduction in pulmonary vein stenosis and collateral damage with pulsed field ablation compared with radiofrequency ablation in a canine model. Circ. Arrhythmia Electrophysiol. 2020;13, e008337.
[23] Lindemann F, Nedios S, Seewöster T, Hindricks G. Pulmonalvenenisolation bei vorhofflimmern mittels pulsed field ablation.Herz 2021;46, 318-322.
[24] Verma A, Boersma L, Haines DE, et al. First-in-human experience and acute procedural outcomes using a novel pulsed field ablation system: The PULSED AF Pilot Trial. Circ Arrhythm Electrophysiol. 2022; 15:e010168.
[25] Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019; 74: 315-26.
[26] ClinicalTrials.gov. A Safety and Feasibility Study of the FARAPULSE Endocardial Ablation System to Treat Paroxysmal Atrial Fibrillation. ClinicalTrials.gov Identifier: NCT03714178. Available at: https://clinicaltrials.gov/ct2/show/NCT03714178 (accessed 13 December 2022).
[27] Sanchez-Somonte P, Verma A. Globe Pulsed Field System for High-definition Mapping and Ablation for Atrial Fibrillation. Heart Int. 2022; 16(2):85-90.
[28] Reddy V, Dukkipati S, Neuzil P, Anic A, Petru J, Funasako M et al. Pulsed field ablation of paroxysmal atrial fibrillation; 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol 2021; 7: 614–21.
[29] Boersma L. New energy sources and technologies for atrial fibrillation catheter ablation. Europace. 2022; 24(Suppl 2):ii44-ii51.
[30] Reddy V, Anter E, Rackauskas G, Peichl P, Koruth J, Petru J, et al. Lattice-tip focal ablation catheter that toggles between radiofrequency and pulsed field energy to treat atrial fibrillation. Circ Arrhythm Electrophysiol 2020;13:e008718
[31] Simon R, Mehta NK, Shah KB, Haines DE, Linte CA. Toward a Quasi-dynamic Pulsed Field Electroporation Numerical Model for Cardiac Ablation: Predicting Tissue Conductance Changes and Ablation Lesion Patterns. Comput Cardiol (2010). 2022; 2022:10.22489/CinC.2022.233.
[32] Koruth JS, Kuroki K, Iwasawa J, et al. Endocardial ventricular pulsed field ablation: A proof-of-concept preclini-cal evaluation[J]. Europace, 2020, 22(3) : 434 -439.
[33] Stewart MT, Haines DE, Verma A, et al. Intracardiac pulsed field ablation: Proof of feasibility in a chronic porcine model[J].Heart Rhythm, 2019, 16( 5) :754 -764.
[34] Stewart MT, Haines DE, Miklav i D, et al. Safety and chronic lesion characterization of pulsed field ablation in a porcine model[J]. J Cardiovasc Electrophysiol, 2021, 32( 4) : 958 -969.
[35] Witt CM, Sugrue A, Padmanabhan D, et al. Intrapulmonary vein ablation without stenosis: A novel balloon-based direct current electroporation approach[J]. J Am Heart Assoc, 2018, 7 ( 14) : e009575.
[36] Hong J, Stewart MT, Cheek DS, et al. Cardiac ablation via electroporation[J]. Annu Int Conf IEEE Eng Med Biol Soc, 2009: 3381-3384.
[37] Koruth J, Kuroki K, Iwasawa J, et al. Preclinical evalua-tion of pulsed field ablation: Electrophysiological and histological assessment of thoracic vein isolation[J]. CircArrhythm Electrophysiol, 2019, 12( 12) : e007781.
[38] Bradley CJ, Haines DE.Pulsed field ablation for pul-monary vein isolation in the treatment of atrial fibril-lation [J].J Cardiovasc Electrophysiol, 2020, 31(8):2136-2147.
[39] Livia C, Sugrue A, Witt T, et al. Elimination of Purkinje fibers by electroporation reduces ventricular fibrillation vulnerability[J]. J Am Heart Assoc, 2018, 7 ( 15) :e009070.
[40] Barkagan M, Contreras-Valdes FM, Leshem E, et al. High-power and short-duration ablation for pulmonary vein isolation: Safety, efficacy, and long-term durability[J]. J Cardiovasc Electrophysiol, 2018, 29( 9) : 1287 -1296.
[41] Bourier F, Duchateau J, Vlachos K, et al. High-power short-duration versus standard radiofrequency ablation: In-sights on lesion metrics[J]. J Cardiovasc Electrophysiol, 2018, 29( 11) : 1570 -1575.
[42] Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation [J]. JAm Coll Cardiol, 2019, 74( 3) : 315 -326.
[43] Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation[J].N Engl J Med, 2016, 374( 23) : 2235 -2245.