Pulsed field ablation

Pulsed field ablation (PFA) is a new energy source for treating cardiac arrhythmias—heart rhythm problems—especially atrial fibrillation. Cardiac ablation targets and eliminates small areas of heart tissue causing abnormal electrical signals, which helps correct irregular heart rhythms. With PFA, quick electrical pulses are used to destroy targeted heart tissue. These pulses create tiny openings in the cell membranes, causing the cells to die. Even more than traditional ablation methods that use heat or cold, PFA is highly selective for heart tissue, which may reduce the risk of damage to nearby structures.

Penn Medicine excels in cardiac arrhythmia care with more than 40 years of innovation and research leadership. Our electrophysiology specialists, who focus on the heart’s electrical system, use the latest technology and state-of-the-art imaging and labs to offer precise, safe treatments tailored to each patient.

PFA is typically used for people who:

• Have atrial fibrillation (AFib) that can't be controlled with medications
• Have paroxysmal AFib, where episodes last less than a week
• Have early persistent AFib lasting over a week
• Are at higher risk of complications from traditional ablation

The decision to use PFA treatment is made by a heart rhythm specialist (an electrophysiologist), who will consider your eligibility based on your specific condition, previous treatments, and overall health.

PFA is minimally invasive, meaning it uses small incisions and catheters to access the heart. It’s often faster than traditional ablation methods, usually taking less than two hours.

You may be given general anesthesia for PFA, which puts you into a deep sleep during the procedure, or sedation, which helps you feel relaxed and comfortable while breathing on your own.

During the PFA procedure, you may expect the following steps:

• Thin tubes called catheters are inserted through veins in your groin and guided to your heart. 
• The electrophysiologist may map the electrical activity of the heart to pinpoint the specific areas that need treatment.
• Once placed in its desired position, the PFA catheter sends quick, high-energy electrical pulses to targeted areas of the heart.
• These pulses create small scars that block the abnormal electrical signals causing the irregular heartbeat.
• Your heart’s activity is checked to ensure that the targeted areas have been effectively treated.

After the catheters have been removed, you’ll be taken to a recovery area, where your heart rhythm and vital signs will be closely monitored for a few hours.

Because PFA is minimally invasive and often takes less time than traditional ablation, post-surgery recovery time may be faster as well. Most people go home the day after the procedure.

You’ll be advised to take it easy for the first few days, avoiding heavy lifting and vigorous exercise. Walking and light movement are usually encouraged. Most people are able to return to normal activities, including work, within a week, but follow your doctor’s specific instructions for rest and recovery.

It’s common to have some irregular heartbeats or mild symptoms in the weeks following PFA as the heart heals. Follow-up appointments allow your care team to continue monitoring your healing and track any recurrence of arrhythmias.

PFA is generally well tolerated and considered safer than traditional ablation methods, but like any medical procedure, it carries some risks.

• Damage to surrounding tissues: While PFA is designed to target heart tissue very precisely, there is still a slight risk of affecting nearby structures like the esophagus or phrenic nerves.
• Blood vessel injury: Catheter insertion can sometimes cause damage to blood vessels, leading to bleeding or clot formation.
• Arrhythmia recurrence: In some cases, the arrhythmia may return after PFA, requiring additional procedures or treatments.
• Infection or bleeding: There’s a risk of infection at the catheter insertion sites, as well as minor bleeding or bruising.

Penn Medicine is the top regional and national referral center for advanced cardiac arrhythmia treatments. Our electrophysiology team is internationally recognized, contributing to global symposiums and publishing in major medical journals. They have pioneered many modern ablation techniques now used in medical centers worldwide.

With expertise in treating complex arrhythmias that don’t respond to standard therapies, Penn Medicine’s specialists develop individualized treatment plans tailored to each person’s needs. Our goal is to offer you the most effective care to improve your heart health and quality of life.