Your heart is the most important muscle in your body. Naturally, you want it to work at its best. Conditions like arrhythmias can throw off your heart’s normal rhythm but the right care can help get your heart back to beating efficiently.
Pulsed field ablation (PFA) is a procedure used to treat heart arrhythmias by targeting the specific heart tissue that causes an irregular heartbeat. If you’re exploring care options for an arrhythmia or your cardiologist has mentioned PFA as a treatment, keep reading to learn how the procedure works and what to expect.
What is pulsed field ablation?
A pulsed field ablation is a procedure that uses short electrical pulses to create tiny holes in the cell membranes of heart tissues – a process called electroporation. These holes block the electrical signals responsible for arrhythmias.
PFA is a type of catheter ablation, meaning that the procedure is performed using a thin tube (catheter) that is inserted into a blood vessel and guided up to the heart. Because it doesn’t require a large incision, catheter ablation (also called cardiac ablation) is considered a minimally invasive procedure.
Pulsed field ablation vs. other types of cardiac ablation
Pulsed field ablation is just one type of ablation that cardiologists typically use to treat heart arrhythmias. Radiofrequency ablation, a procedure that uses heat, and cryoablation, a procedure that uses cold, are common types of thermal cardiac ablation.
Some of the basic differences between PFA and other cardiac ablation methods include:
| Pulsed field ablation | Thermal catheter ablation | |
|---|---|---|
| How the procedure works | Short electrical pulses are used to create tiny holes that block electrical signals. | Thermal ablation uses heat or cold to disable the heart tissue that triggers abnormal electrical signals. |
| When it’s used | Often used for arrhythmias, such as atrial fibrillation (AFib), that occur close to sensitive areas, like the esophagus or nerves. | Well suited for arrhythmias in areas where heat or cold can be applied without damaging nearby nerves, organs or other critical structures. |
| Recovery time | Many people go home the same day or day after the procedure. | Many people go home the same day as the procedure, while others stay a night or two in the hospital. |
| Average length of procedure | 1-2 hours | 2-6 hours |
Keep in mind that factors like your specific condition, lifestyle, overall health, family history and previous treatments can affect your treatment options. Your doctor will develop a personalized treatment plan that will be the safest, best option for you.
Why your doctor might recommend pulsed field ablation
There are a few reasons that PFA might be the recommended treatment for your heart. It might be the right treatment if:
- Your condition is not sufficiently managed with medication
- You have paroxysmal AFib (AFib that lasts a few hours or days, but less than a week)
- You’ve been diagnosed with persistent AFib (continuous AFib that lasts more than a week)
- Your arrhythmia is close to tissues or structures that may make thermal ablation less safe for you
- You have congestive heart failure and AFib
Even if your circumstances and condition are different, you can always ask your cardiologist if PFA would be a good option for treating your arrhythmia.
Pulse field ablation could be the best treatment for some types of arrhythmias
One of the benefits of PFA is that the electrical pulses can specifically target the tissues that are causing an irregular heartbeat without affecting nearby structures, such as nerves going to the lungs and the esophagus. While it is a promising treatment, PFA hasn’t been studied in all arrhythmias. Your doctor can recommend the procedure if it’s right for you.
Pulsed field ablation is safe for most people
Pulsed field ablation has a very low rate of major complications and is generally considered safe for treating arrhythmias. PFA shares many of the same general risks as other catheter ablation techniques, including blood clots, fluid buildup, heart wall punctures, and damage to blood vessels and organs around the heart.
Some research suggests PFA may actually reduce the risk of damage to certain nearby structures, such as the esophagus and phrenic nerve, compared with thermal ablation methods. This is a positive sign for treating AFib and other arrhythmias that are commonly located close to these areas.
You can have more than one pulsed field ablation procedure
It’s fairly common for people to need a repeat ablation procedure to manage future symptoms. This is true of all ablation techniques, not just PFA.
After cardiac ablation, your cardiologist will monitor your heart health for signs that you may need another treatment. There isn’t a specific limit on how many times you can have a heart ablation, but if your arrhythmia returns, your cardiologist may recommend a different procedure or treatment option that may work better for you.
What to expect during a pulsed field ablation procedure
Pulsed field ablation is performed by an electrophysiologist (a cardiologist that specializes in heart rhythms and electrical systems) and usually takes less than two hours. A PFA is most often performed under general anesthesia following these basic steps:
- Thin catheters with electrodes at the end are inserted into a blood vessel, usually near the femoral vein (a blood vessel in the thigh).
- The electrophysiologist guides the catheters to the part of the heart that needs ablating.
- Short, targeted electrical pulses are administered to the tissue. Whether there is only one area that needs treatment or multiple, each is treated at least twice.
- Your care team will check your heart activity. They can often confirm that the targeted areas have been treated, but long-term success will need to be evaluated over time.
Most people go home the same day or the day after a PFA, although you can expect some minor side effects could linger for up to a few weeks. Your doctor will tell you what to expect during your recovery, as well as possible complications to watch for.
Get the arrhythmia care your heart needs
Finding care you need and a doctor you can trust is important for ensuring you’re taking the best steps for your health. If you’re interested in learning if a PFA is right for you, talking with your cardiologist is a good place to start. They will be able to guide you through this decision and make sure it’s the best choice for your heart. Your cardiologist can also connect you with an electrophysiologist if you need one.
If you’re looking for a cardiologist to support your heart health, we have dozens of award-winning doctors to choose from. We don’t require a doctor’s referral before you make an appointment, but you should check with your health insurance plan so you understand your coverage for specialty care.