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Review
. 2024 Aug 10;5(9):655-661.
doi: 10.1016/j.hroo.2024.08.002. eCollection 2024 Sep.

Considerations regarding safety with pulsed field ablation for atrial fibrillation

Alan Sugrue  1 , Samuel Shabtaie  1 , Nicholas Y Tan  1 , Elad Maor  2 , Suraj Kapa  1 , Samuel J Asirvatham  1
Affiliations
Review

Considerations regarding safety with pulsed field ablation for atrial fibrillation

Alan Sugrue et al. Heart Rhythm O2. .

Abstract

The introduction of pulsed field ablation (PFA) in electrophysiology marks a significant advancement, promising efficacy comparable to thermal ablation methods while potentially providing safety advantages. Despite a generally favorable safety profile in human trials and postmarket registries, cautious evaluation of PFA's safety is essential. This review provides a comprehensive overview of key safety considerations as we discuss a myriad of considerations ranging from thermal effects, gaseous microbubble formation, muscle contractions, and proarrhythmia to procedural techniques. We explore specific safety concerns with phrenic nerve injury, cerebral lesions, coronary artery spasm, hemolysis and pulmonary bleeding. Vigilance in safety monitoring, coupled with advancements in procedural techniques and understanding of PFA's unique effects, is crucial for optimizing the safe and effective use of PFA.

Keywords: Atrial fibrillation; Pulsed field ablation; Safety considerations.

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Figures

None
Graphical abstract
Figure 1
Figure 1
The impact of an electric pulse can vary, including reversible electroporation, irreversible electroporation, and thermal damage. Longer pulse durations and higher voltages increase the likelihood of causing irreversible damage and potential thermal effects. Reprinted with permission from Maor, Sugrue and colleagues.
Figure 2
Figure 2
Risk of hemolysis with tissue contact. With no tissue contact risk of hemolysis increases. Created with BioRender.com
See this image and copyright information in PMC

References

    1. Reddy V.Y., Gerstenfeld E.P., Natale A., et al. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation. N Engl J Med. 2023;389:1660–1671. - PubMed
    1. Verma A., Haines D.E., Boersma L.V., et al. Pulsed field ablation for the treatment of atrial fibrillation: PULSED AF pivotal trial. Circulation. 2023;147:1422–1432. - PMC - PubMed
    1. Verma A., Boersma L., Haines D.E., et al. First-in-human experience and acute procedural outcomes using a novel pulsed field ablation system: the PULSED AF pilot trial. Circ Arrythm Electrophysiol. 2022;15 - PMC - PubMed
    1. Reddy V.Y., Dukkipati S.R., Neuzil P., et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II. Clinical Electrophysiology. 2021;7:614–627. - PubMed
    1. Reddy V.Y., Neuzil P., Koruth J.S., et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019;74:315–326. - PubMed

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