Advancing atrial fibrillation treatment with pulsed field ablation

By Nisreen Yaghmour, MD, ProHealth Care electrophysiologist

Atrial fibrillation, commonly called AFib, is the most common sustained heart rhythm disorder. In a healthy heart, electrical signals travel in an organized pattern, causing the upper and lower chambers to beat in coordination. In AFib, those signals become chaotic. The atria, or upper chambers of the heart, quiver rapidly instead of contracting effectively.

For many people, the condition feels like a racing, fluttering or pounding heartbeat. Others experience fatigue, dizziness, shortness of breath, chest discomfort or reduced exercise tolerance. Some people have no symptoms at all and discover the condition during a routine medical exam. AFib can increase the risk of stroke, heart failure and other cardiovascular complications.

Treatment for AFib is individualized and may include medications, lifestyle modification and catheter ablation. For patients with symptomatic AFib, catheter ablation may be recommended to help maintain a normal heart rhythm when medications are not effective or tolerated.

For years, catheter ablation has relied mainly on radiofrequency ablation, which uses heat, or cryoablation, which uses extreme cold, to destroy areas responsible for irregular electrical activity. Both approaches can be highly effective, but they require precision because nearby structures such as the esophagus, nerves and blood vessels can also be affected.

A newer technology called pulsed field ablation, or PFA, is changing how many specialists approach AFib treatment.

Unlike traditional ablation methods that use heat or extreme cold, pulsed field ablation uses rapid bursts of electrical energy, often lasting only fractions of a second, to target heart tissue involved in abnormal rhythms. These electrical pulses create tiny openings in the membranes of select heart cells through a process called irreversible electroporation. Over time, the targeted cells lose their ability to function normally and are cleared away by the body.

Pulsed field ablation is especially precise, selectively affecting heart muscle tissue while potentially sparing many surrounding structures. Heart cells are particularly sensitive to the electrical fields used during the procedure, while nearby tissues may be more resistant. This selectivity has made PFA an important advancement in modern electrophysiology.

The procedure is performed in a specialized electrophysiology lab. Patients are usually placed under general anesthesia or deep sedation. Physicians insert thin flexible tubes called catheters through veins, typically near the groin, and guide them into the heart using imaging and advanced electrical mapping systems.

Most AFib originates near the pulmonary veins, which carry oxygen-rich blood from the lungs into the left atrium. During pulsed field ablation, a specialized catheter is positioned around these veins. Short bursts of electrical pulses are then delivered to create precise areas of treated tissue that block abnormal electrical pathways.

After the procedure, many patients return home the same day. Some may require an overnight hospital stay. Mild soreness, bruising near the catheter insertion site or temporary fatigue can occur during recovery.

Some patients may experience brief episodes of irregular rhythm during the first few weeks or months as inflammation subsides and heart tissue stabilizes. Physicians sometimes continue medications temporarily during this healing period.

ProHealth Care’s electrophysiology team uses Abbott’s Volt Pulsed Field Ablation System. The system is designed to support efficient procedures, and PFA has shown effectiveness comparable to traditional ablation techniques in many patients with AFib.

Pulsed field ablation is not considered a cure for every patient with AFib. Success rates can depend on factors such as how long the condition has been present, whether the AFib is intermittent or persistent, the size of the atria and the patient’s overall cardiovascular health. Some individuals may require repeat procedures or additional therapies.

Even so, PFA represents an important evolution in the treatment of atrial fibrillation. As patients regain normal heart rhythm, they may experience better exercise tolerance, improved sleep and a reduced emotional burden associated with chronic heart rhythm problems.

Pulsed field ablation may become a defining development in the future of cardiac rhythm care as physicians work to support safe and effective care for millions of patients living with irregular heart rhythms.

Nisreen Yaghmour, MD, is a ProHealth Care electrophysiologist who performs pulsed field ablation in the electrophysiology lab at ProHealth Waukesha Memorial Hospital. Call 262-928-8800 to schedule an appointment with any member of the electrophysiology team or learn more.