menuclose
What is Pulsed Field Ablation?
Pulsed Field Ablation (PFA) is a novel cardiac ablation procedure for the treatment of atrial fibrillation (AF). Compared to traditional ablation methods, which use heat or cold energy, the PFA catheter procedure is a non-thermal and selective tissue approach that uses high-energy electrical pulses to precisely target cardiac cells that are known to cause arrhythmias.1
What happens during the Pulsed Field Ablation (PFA) Procedure?
During the procedure, the patient is under sedation or general anaesthesia. A small catheter is inserted through the femoral vein (located in the groin) and guided to the upper heart chamber, the atrium.
High voltage, rapid electrical pulses are delivered to the tissue to deliberately cause cell death of abnormal cells that cause arrhythmias. This process is called irreversible electroporation.2
The strength of the electrical pulses can be carefully determined to destroy cardiac muscle cells (cardiomyocytes) and not the surrounding tissues, such as the oesophagus, phrenic nerve and pulmonary vein.2
Following the procedure, many patients may go home the same day or the next day from hospital. Patients have minimal downtime and will typically only experience slight discomfort at the incision site in the groin.
The procedure is performed by a Cardiologist who specialises in cardiac electrophysiology and the treatment of heart rhythm disorders, along with a team of nurses and technicians who assist during the procedure.
In the video below, Cardiac Electrophysiologist Dr Wai Kah Choo explores how the ablation procedure has evolved, what makes pulsed field ablation different to other catheter ablation modalities, and why atrial fibrillation may return for some patients.
What are the advantages of Pulsed Field Ablation?
Pulsed field ablation (PFA) may provide the following advantages for atrial fibrillation patients:
- Safer procedure: Reduced risk of damage to other nearby organs during the procedure and fewer complications compared to alternative treatments.3
- Shorter procedure: Faster procedure times reduce the time a patient is under anesthesia, reduce the risk of stroke and potentially reduce surgical waitlists for patients requiring AF treatment.4
- Procedure precision: The tissue selection with PFA limits damage to surrounding tissues, nerves and veins such as the oesophagus.3
- Fewer complications: PFA has been found to result in less inflammation and scarring compared to traditional ablation methods.5
Cardiac Electrophysiologist Dr Wai Kah Choo discusses the advantages of the Pulsed Field Ablation procedure for Atrial Fibrillation in the video below:
What are the limitations of Pulsed Field Ablation?
Pulsed field ablation (PFA) is a promising technology in the field of electrophysiology that is being utilised by a growing number of cardiac electrophysiologists internationally and in Australia. However, since it is an emerging treatment modality, it has limited long-term data at this stage.6
Lastly, PFA is a new therapy that may not be widely available across Australia.
What is the cost associated with Pulsed Field Ablation?
The cost of pulsed field ablation can vary depending on the facility, length of hospital stay, medical insurance, and physician fees.
Due to the reduced procedure time, PFA has been demonstrated to be more cost-effective when compared to other traditional ablation procedures currently used.7 Conversely, the availability and further specialised training required to perform the procedure may limit accessibility for some patients.8
In the video below, Dr Wai Kah Choo takes us through the cost considerations for the PFA procedure, including medical insurance, waitlists and how reoccurring episodes of atrial fibrillation can impact the overall cost to the patient and healthcare system.
Is Pulsed Field Ablation available in Australia?
Yes, pulsed field ablation is available in Australia across a number of public and private hospitals. It was first performed in 2022 at the Prince Charles Hospital in Brisbane by Cardiac Electrophysiologist Associate Professor Haris Haqqani.
In April 2023, the Therapeutic Goods Administration (TGA) approved the use of the FARAPULSE™ Pulsed Field Ablation (PFA) System developed by Boston Scientific, which is currently the only approved PFA system in Australia.9
