Pulsed Field Ablation

A novel approach to cardiac ablation and the treatment of cardiac arrhythmias

Learn what sets pulsed field ablation apart from thermal ablation modalities and the science behind irreversible electroporation and its application in the treatment of cardiac arrhythmias.

Section Advisor: Prof Lucas Boersma

Lucas Boersma

Radcliffe Cardiology

This resource hub is supported by

The Fundamentals of PFA

The Fundamentals of Electroporation

Prof Damijan Miklavcic discusses how electroporation works, where it is used today and more.

The Fundamentals of Tissue Selectivity

Prof Damijan Miklavcic discusses tissue selectivity and what occurs on a cellular level.

PFA: Preclinical Evidence Review

Pulsed Field Ablation: Preclinical Evidence Review

Prof David Haines explores on the potential benefits of PFA, PFA ablation characteristics and more.

An Overview of PFA

An Overview of Pulsed Field Ablation

Dr Atul Verma presents a comprehensive overview of PFA, offering expert insights.

Featured Video

Pulsed Field Ablation – Safety Considerations

In this video, Dr Atul Verma provides an insightful overview of the safety considerations associated with PFA.

This content was provided by Medtronic.

Key PFA Highlights From Congresses

PulseSelect Real World Experience

HRS PulseSelect Real World Experience

Dr Arash Aryana talks through the clinical insights on using the PulseSelect PFA system for treating paroxysmal and persistent atrial fibrillation.

SPHERE Per-AF Results

HRS 2024: SPHERE Per-AF Study

Dr Elad Anter presents the SPHERE Per-AF IDE comparing Affera Sphere-9 with Thermocool STSF for treating Persistent AF.

MANIFEST-PF

AFSymposium 24: MANIFEST-PF: Impact of LAPW Ablation During PFA for Persistent AF

AF Symposium 2024 – In this interview, investigator Dr Mohit K Turagam (Icahn School of Medicine at Mount Sinai, US) discusses the findings of a sub-study of the MANIFEST-PF registry.

Long-Term Effects of PFA

AFSymposium 24: Long-Term Effects of Pulsed Field Ablation on Coronary Arteries

Dr Yury Malyshev (Mount Sinai Hospital, US) joins us to discuss the findings from three studies focusing on the long-term effects of pulsed-field ablation (PFA) on coronary arteries.

Case Retrospective

RIO 2022 – Case Retrospective: Pulsed Field and Radiofrequency Ablation of Atrial Fibrillation Using Novel Focal Lattice Tip Catheter with Zero Fluoroscopy

Following the success of Rhythm Interventions Online 2022 (30 November – 2 December 2022), here Course Co-director and operator Dr Devi Nair reviews her Pulsed Field and Radiofrequency Ablation of Atrial Fibrillation Using Novel Focal Lattice Tip Catheter with Zero Fluoroscopy case performed live at the event.

The Five 'S' Strategy

RIO 2022 – Case Retrospective: Pulsed Field Ablation Using Sedation – The Five 'S' Strategy

Following the success of Rhythm Interventions Online 2022 (30 November – 2 December 2022), here Course Co-director and operator Prof Julian Chun reviews his Pulsed Field Ablation Using Sedation – The Five 'S' Strategy case performed live at the event.

The PULSED AF Trial

ACC 23: Pulsed Field Ablation in Persistent Atrial Fibrillation Patients: The PULSED AF Trial

Principal Investigator, Dr Atul Verma (McGill University Health Centre, CA) joins us on-site at ACC's 2023 Scientific Sessions to outline the findings of the PULSED-AF Trial (Medtronic Cardiac Rhythm and Heart Failure) (NCT04198701).

"Single Shot" PFA Catheter

EHRA 24: FIH Clinical Series of Conformable "Single Shot" PFA Catheter for PVI

EHRA 24 - We interview Dr Vivek Reddy (Icahn School of Medicine at Mount Sinai, US) on a first-in-human clinical trial of a novel conformable "single-shot" pulsed field ablation (PFA) catheter for pulmonary vein isolation (PVI).

The ADVENT RCT Results

The ADVENT RCT Results - FARAPULSE PFA vs. Thermal Standard-of-Care Ablation

Dr Vivek Reddy provides an overview of the ADVENT RCT results.

Novel Anatomical PFA

Raising the Bar in Pulsed Field Ablation Safety and Procedural Workflow With a Novel Anatomical PFA

Prof Gerhard Hindricks presents insights on elevating safety and improving procedural workflow in PFA.

Energy Source Selection

Energy Source Selection and Optimising Outcomes for AF Ablation

Dr Melanie Gunawardene presents Energy Source Selection and Optimising Outcomes for AF Ablation - The Case for PFA.

PFA Live Cases

PVI With the Sphere-9 Catheter

Live case: PVI With the Sphere-9 Catheter

In this PFA Live Case Summit you will see the Affera mapping and ablation system and lattice tip catheter used to treat a persistent AF patient.

PVI With PulseSelect PFA and 3D Mapping

Live Case: PVI With PulseSelect PFA and 3D Mapping

In this PFA Live Case Summit a circular array catheter will be used along with 3D mapping to conduct PV isolation.

VT Ablation With Sphere-9 Catheter

Live Case: VT Ablation With Sphere-9 Catheter

In this PFA Live Case Summit Prof Josef Kautzner will discuss the use of a focal lattice-tip to treat VT.

PVI With Sphere-360 Single Shot PFA

Live Case: PVI With Sphere-360 Single Shot PFA

In this PFA Live Case Summit Dr Vivek Reddy will discuss the use of a conformable lattice single shot PFA Catheter to treat a PAF patient.

RIO 2023 – Persistent AF

Persistent AF – High Density Mapping and Toggling PFA/RFC Ablation Based on Substrate

Prof Julian Chun and Dr Boris Schmidt present a live case from Rhythm Interventions Online 2023.

RIO 2023 – Future Options for AF Patients

Future Options for AF Patients – One-Stop Shop PVI + LAAC

Prof Julian Chun and Dr Boris Schmidt present a live case from Rhythm Interventions Online 2023.

Key PFA Trials

SPHERE Per-AF Pivotal Trial

Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial versus Thermocool STSF

Anter E, Mansour M, Nair DG, et al. Nat Med 2024;30:2303–10.

PULSED AF Pivotal Trial

Pulsed field ablation for the treatment of atrial fibrillation: PULSED AF pivotal trial

Verma A, Haines DE, Boersma LV, et al. Circulation 2023;147:1422–32.

ADMIRE Trial

Pulsed field ablation to treat paroxysmal atrial fibrillation: safety and effectiveness in the ADMIRE pivotal trial

Reddy VY, Calkins H, Mansour M, et al. Circulation 2024; epub ahead of press.

ADVENT Pivotal Trial

Pulsed field vs conventional thermal ablation for paroxysmal atrial fibrillation: recurrent atrial arrhythmia burden

Reddy VY, Mansour M, Calkins H, et al. J Am Coll Cardiol 2024;84:61–74.

PFA Registry and Survey Data

MANIFEST-17K Study

Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study

Ekanem E, Neuzil P, Reichlin T, et al. Nat Med 2024;30:2020–9.

MANIFEST-PF Registry

Safety and effectiveness of pulsed field ablation to treat atrial fibrillation: one-year outcomes from the MANIFEST-PF registry

Turagam MK, Neuzil P, Schmidt B, et al. Circulation 2023;148:35–46.

Clinical Outcomes by Sex

Clinical outcomes by sex after pulsed field ablation of atrial fibrillation

Turagam MK, Neuzil P, Schmidt B, et al. JAMA Cardiol 2023;8:1142–51.

EU-PORIA Registry

EUropean real-world outcomes with Pulsed field ablatiOn in patients with symptomatic atRIAl fibrillation: lessons from the multi-centre EU-PORIA registry

Schmidt B, Bordignon S, Neven K, et al. Europace 2023;25:euad185.

MANIFEST-PF

Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)

Ekanem E, Reddy VY, Schmidt B, et al. Europace 2022;24:1256–66.

Additional Publications

Cardiac Ablation With Pulsed Electric Fields

Cardiac ablation with pulsed electric fields: principles and biophysics

Sugrue A, Maor E, Del-Carpio Munoz F, et al. Europace 2022;24:1213–22.

Secondary Analysis of the PULSED AF Trial

Prevalence, timing, and impact of early recurrence of atrial tachyarrhythmias after pulsed field ablation: A secondary analysis of the PULSED AF trial

Boersma LVA, Natale A, Haines D, et al. Heart Rhythm 2024; epub ahead of press.

PULSE-EU Trial

AF ablation using a novel "single-shot" map-and-ablate spherical array pulsed field ablation catheter: 1-Year outcomes of the first-in-human PULSE-EU trial

Turagam MK, Neuzil P, Petru J, et al. Heart Rhythm 2024;21:1218–26.

Highlights From 2023

The year in electrophysiology: selected highlights from 2023

Poorsattar SP, Kumar N, Vanneman M, et al. J Cardiothorac Vasc Anesth 2024;38:1641–9.

Large Footprint Focal Catheter

A large footprint focal catheter toggling between pulsed field and radiofrequency energy: first clinical experience for ventricular tachycardia ablation

Pannone L, Doundoulakis I, Cespón-Fernández M, et al. Europace 2024;26:euae193.

Catheter and Surgical Ablation for AF

2023 Cardiac Society of Australia and New Zealand Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation

Kistler PM, Sanders P, Amarena JV, et al. Heart Lung Circ 2024;33:828–81.

Patients With Recurrences

Pulsed field ablation for atrial fibrillation in real-life settings: Efficacy, safety, and lesion durability in patients with recurrences

Benali K, Vlachos K, Reddy VY, et al. Heart Rhythm 2024;21:962–4.

Pulsed-Field vs Cryoballoon vs Radiofrequency

Pulsed-field vs cryoballoon vs radiofrequency ablation: outcomes after pulmonary vein isolation in patients with persistent atrial fibrillation

Kueffer T, Stettler R, Maurhofer J, et al. Heart Rhythm 2024;21:1227–35.

PFA of the Right Superior Pulmonary Vein

Pulsed field ablation of the right superior pulmonary vein prevents vagal responses via anterior right ganglionated plexus modulation

Del Monte A, Della Rocca DG, Pannone L, et al. Heart Rhythm 2024;21:780–7.

Evolution and Future Perspective

State-of-the-art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective

Chun KJ, Miklavčič D, Vlachos K, et al. Europace 2024;26:euae134.

Results of a Multicenter, Real-world Experience

Pulsed field vs very high-power short-duration radiofrequency ablation for atrial fibrillation: Results of a multicenter, real-world experience

Dello Russo A, Compagnucci P, Anselmino M, et al. Heart Rhythm 2024; epub ahead of press.

Sequential Unipolar Biventricular PFA

Sequential unipolar biventricular pulsed field ablation for refractory intramural septal ventricular tachycardia

Cespón-Fernández M, Pannone L, Della Rocca D, et al. JACC Case Rep 2024;29:102356.

InspIRE

Predictors of success for pulmonary vein isolation with pulsed-field ablation using a variable-loop catheter with 3D mapping integration: complete 12-month outcomes from inspIRE

De Potter T, Grimaldi M, Duytschaever M, et al. Circ Arrhythm Electrophysiol 2024;17:e012667.

Repeat Catheter Ablation

Repeat catheter ablation for atrial fibrillation

Brahier MS, Friedman DJ, Bahnson TD, Piccini JP. Heart Rhythm 2024;21:471–83.

ADVENT Trial

Comparison of cerebral safety after atrial fibrillation using pulsed field and thermal ablation: Results of the neurological assessment subgroup in the ADVENT trial

Patel C, Gerstenfeld EP, Gupta SK, et al. Heart Rhythm 2024; epub ahead of press.

PFA vs Thermal Ablation

Cost, efficiency, and outcomes of pulsed field ablation vs thermal ablation for atrial fibrillation: a real-world study

Calvert P, Mills MT, Xydis P, et al. Heart Rhythm 2024; epub ahead of press.

Expert Consensus Statement

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

Tzeis S, Gerstenfeld EP, Kalman J, et al. Heart Rhythm 2024; epub ahead of press.

Pulsed Field and Radiofrequency Ablation

A novel platform allowing for pulsed field and radiofrequency ablation: first commercial atrial fibrillation ablation procedures worldwide with and without general anesthesia

Metzner A, Rottner L, Moser F, et al. Heart Rhythm 2024;21:497–8.

Case Report

Case report: pulsed field ablation for epicardial right-sided accessory pathway

Haskova J, Peichl P, Borisincova E, Kautzner J. Front Cardiovasc Med 2024;11:1392264.

PFA Durability

Is seeing believing? Adding another tool to assess PFA durability

Mehta NK, Haines DE. Circ Arrhythm Electrophysiol 2024;17:e012773.

Endocardial PFA and the Oesophagus

Endocardial pulsed field ablation and the oesophagus: are atrio-oesophageal fistulas now history?

Nies M, Watanabe K, Kawamura I, Koruth JS. Arrhythm Electrophysiol Rev 2024;13:e02.

Learning Before Burning

Learning before burning: mapping with reversible pulsed field ablation

Ashur C, Tzou WS. Circ Arrhythm Electrophysiol 2024;17:e012430.

2023 ACC/AHA/ACCP/HRS Guideline

2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines

Writing Committee Members, Joglar JA, Chung MK, et al. J Am Coll Cardiol 2024;83:109–279.

Emerging Tools and Techniques

Emerging tools and techniques for catheter ablation of cardiac arrhythmias: a 2024 update

Aryana A, D'Avila A. J Innov Card Rhythm Manag 2024;15:5718–27.

Coronary Artery Spasm

Coronary artery spasm during pulsed field vs radiofrequency catheter ablation of the mitral isthmus

Zhang C, Neuzil P, Petru J, et al. JAMA Cardiol 2024;9:72–7.

2023 ACC/AHA/ACCP/HRS Guideline

Joglar JA, Chung MK, Armbruster AL, et al. Circulation 2024;149:e1–e156.

Paroxysmal Atrial Fibrillation Ablation

Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison

Della Rocca DG, Marcon L, Magnocavallo M, et al. Europace 2024;26:euae016.

Effects of Contact Force on Lesion Size

Effects of contact force on lesion size during pulsed field catheter ablation: histochemical characterization of ventricular lesion boundaries

Nakagawa H, Castellvi Q, Neal R, et al. Circ Arrhythm Electrophysiol 2024;17:e012026.

Guideline-Based Care for Atrial Fibrillation

Expert consensus on comprehensive early rhythm control in addition to guideline-based care for atrial fibrillation: a modified Delphi survey

Deering TF, Piccini JP, Graf M, et al. Am J Cardiol 2023;207:328–35.

Durability of PVI

Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review

Serban T, Mannhart D, Abid QU, et al. Europace 2023;25:euad335.

Promise of PFA

The promise of pulsed field ablation and the challenges ahead

Iyengar SK, Iyengar S, Srivathsan K. Front Cardiovasc Med 2023;10:1235317.

Secondary Analysis of the PULSED AF Trial

Influence of monitoring and atrial arrhythmia burden on quality of life and health care utilization in patients undergoing pulsed field ablation: a secondary analysis of the PULSED AF trial

Verma A, Haines DE, Boersma LV, et al. Heart Rhythm 2023;20:1238–45.

Nonthermal Point-by-Point PVI

Nonthermal point-by-point pulmonary vein isolation using a novel pulsed field ablation system

Wenzel JP, Lemoine MD, Rottner L, et al. Circ Arrhythm Electrophysiol 2023;16:e012093.

Predicting Lesion Durability

Predicting lesion durability with PFA: one step closer

Koruth JS, Kawamura I. Circ Arrhythm Electrophysiol 2023;16:e012370.

Simultaneous PFA and Mechanical Closure

Simultaneous pulsed field ablation and mechanical closure of left atrial appendage using a novel device

Tang M, Wang X, Reddy VY. JACC Case Rep 2023;22:101963.

25 Years of Europace Journal

Progress in atrial fibrillation ablation during 25 years of Europace journal

Boersma L, Andrade JG, Betts T, et al. Europace 2023;25:euad244.

Efficacy, Safety, and Long-Term Follow-Up

Pulsed field versus cryoballoon pulmonary vein isolation for atrial fibrillation: efficacy, safety, and long-term follow-up in a 400-patient cohort

Urbanek L, Bordignon S, Schaack D, et al. Circ Arrhythm Electrophysiol 2023;16:389–98.

Silent Cerebral Lesions

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review

Calvert P, Kollias G, Pürerfellner H, et al. Europace 2023;25:euad151.

Multicenter inspIRE Study

Paroxysmal atrial fibrillation ablation using a Novel variable-loop biphasic pulsed field ablation catheter integrated with a 3-dimensional mapping system: 1-year outcomes of the multicenter inspIRE study

Duytschaever M, De Potter T, Grimaldi M, et al. Circ Arrhythm Electrophysiol 2023;16:e011780.

Solving the Reach Problem

Solving the reach problem: a review of present and future approaches for addressing ventricular arrhythmias arising from deep substrate

Ravi V, Winterfield J, Liang J, et al. Arrhythm Electrophysiol Rev 2023;12:e04.

Efficacy and Safety of Novel PFA

Efficacy and safety of novel pulsed field ablation (PFA) technique for atrial fibrillation: A systematic review and meta-analysis

Shaheen N, Shaheen A, Ramadan A, Nashwan AJ. Health Sci Rep 2023;6:e1079.

MANIFEST-PF

Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)

Ekanem E, Reddy VY, Schmidt B, et al. Europace 2022;24:1256–66.

Catheter Ablation of AF

Catheter ablation of atrial fibrillation: current status and near future

Yamane T. J Cardiol 2022;80:22–7.

PULSED AF Pilot Trial

First-in-human experience and acute procedural outcomes using a novel pulsed field ablation system: the PULSED AF pilot trial

Verma A, Boersma L, Haines DE, et al. Circ Arrhythm Electrophysiol 2022;15:e010168.

B-Ab06-02 PFA Trains

B-Ab06-02 pulsed field ablation trains reduce tissue impedance in patients undergoing pulmonary vein isolation

Shah KB, Mehta N, Kutinsky IB, et al. Heart Rhythm 2021;18:S10.

B-Po01-047 PFA and Heat Generation

B-Po01-047 pulsed field ablation and heat generation: electrode-tissue temperature analysis from the PULSED AF trial

Verma A, Boersma LVA, Haines DE, et al. Heart Rhythm 2021;18:S70.

Preclinical PFA Data

Effect of Contact Force on PFA Lesions

Effect of contact force on pulsed field ablation lesions in porcine cardiac tissue

Mattison L, Verma A, Tarakji KG, et al. J Cardiovasc Electrophysiol 2023;34:693–9.

Effects of Electrode-tissue Proximity

Effects of electrode-tissue proximity on cardiac lesion formation using pulsed field ablation

Howard B, Verma A, Tzou WS, et al. Circ Arrhythm Electrophysiol 2022;15:e011110.

Characterization of Phrenic Nerve Response

Characterization of phrenic nerve response to pulsed field ablation

Howard B, Haines DE, Verma A, et al. Circ Arrhythm Electrophysiol 2022;15:e010127.

PFA in a Porcine Model

Safety and chronic lesion characterization of pulsed field ablation in a Porcine model

Stewart MT, Haines DE, Miklavčič D, et al. J Cardiovasc Electrophysiol 2021;32:958–69.

Pulmonary Vein Stenosis and Collateral Damage

Reduction in pulmonary vein stenosis and collateral damage with pulsed field ablation compared with radiofrequency ablation in a canine model

Howard B, Haines DE, Verma A, et al. Circ Arrhythm Electrophysiol 2020;13:e008337.

Intracardiac PFA

Intracardiac pulsed field ablation: proof of feasibility in a chronic porcine model

Stewart MT, Haines DE, Verma A, et al. Heart Rhythm 2019;16:754–64.

Expandable Lattice Electrode Ablation Catheter

Expandable lattice electrode ablation catheter: a novel radiofrequency platform allowing high current at low density for rapid, titratable, and durable lesions

Barkagan M, Leshem E, Rottmann M, et al. Circ Arrhythm Electrophysiol 2019;12:e007090.

Novel Radiofrequency Catheter

Novel irrigated temperature-controlled lattice ablation catheter for ventricular ablation: a preclinical multimodality biophysical characterization

Shapira-Daniels A, Barkagan M, Yavin H, et al. Circ Arrhythm Electrophysiol 2019;12:e007661.

Feasibility, Safety, and Durability

Feasibility, safety, and durability of porcine atrial ablation using a lattice-tip temperature-controlled radiofrequency ablation catheter

Koruth JS, Kuroki K, Iwasawa J, at al. J Cardiovasc Electrophysiol 2020;31:1323–31.

Preclinical Assessment

Focal pulsed field ablation for pulmonary vein isolation and linear atrial lesions: a preclinical assessment of safety and durability

Koruth JS, Kuroki K, Kawamura I, at al. Circ Arrhythm Electrophysiol 2020;13:e008716.

PFA in Ventricular Myocardium

Pulsed-field ablation in ventricular myocardium using a focal catheter: the impact of application repetition on lesion dimensions

Yavin HD, Higuchi K, Sroubek J, et al. Circ Arrhythm Electrophysiol 2021;14:e010375.