Foshan Chanyi Hospital Pioneers Pulsed Field Ablation (PFA) for Atrial Fibrillation Treatment in Mainland China

"Unexplained palpitations," "heart racing like a rabbit in the chest"... In daily life, if palpitations occur without an obvious cause, it is necessary to consider heart-related diseases, such as atrial fibrillation.

Atrial fibrillation is one of the most common clinical arrhythmias, primarily triggered by abnormal electrical activity in the pulmonary veins. If left untreated for a prolonged period, it can easily lead to stroke and heart failure, resulting in severe consequences.

Current treatments for atrial fibrillation include medication and surgical procedures. Medications are primarily used to slow the heart rate and provide anticoagulation therapy to prevent thrombosis. Surgical treatments include radiofrequency ablation, cryoablation, and pulsed field ablation, which are effective methods for treating atrial fibrillation.

Currently, catheter ablation for atrial fibrillation is mainly performed using radiofrequency ablation and cryoablation. However, with the continuous advancement of medical technology, cutting-edge techniques such as pulsed field ablation and laser ablation are gradually being applied in clinical practice, offering new options for the treatment of atrial fibrillation.

Pulsed Field Ablation (PFA) is a novel ablation method for treating atrial fibrillation. It applies high-voltage electrical pulses to the cell membrane in a short period, causing irreversible permeabilizing damage to the cell membrane, disrupting intracellular homeostasis, and ultimately leading to apoptosis, achieving the goal of non-thermal ablation.

Compared with traditional radiofrequency and cryoablation, pulsed electric field ablation technology has high tissue selectivity, which can ensure the ablation effect while preventing damage to the adjacent tissues of the target ablation area. It is a relatively safe and efficient ablation method.

As a "rising star" in the field of atrial fibrillation ablation, the FARAPULSE Pulsed Field Ablation (PFA) System received the "Breakthrough Device Designation" from the U.S. FDA in 2019 and obtained EU CE certification in 2021. It is currently used for the treatment of paroxysmal atrial fibrillation (PaAF) in Europe, with a cumulative total of 20,000 real-world clinical cases globally.

Its catheter combines both basket and flower shapes, not only covering the pulmonary vein ostium and the pulmonary vein vestibule for more thorough ablation, but also ushering ablation technology from "point-by-point ablation" into a new era of "stamp ablation."

FARAPULSE Multi-Channel Pulsed Electric FieldThe field ablation system uses a new type of pulsed electric field ablation energy to selectively ablate myocardial tissue while avoiding damage to adjacent tissues. The clinical advantages of this feature include:

1) Pulsed electric fields can maintain the integrity of the tissue matrix within their ablation zone.

2) The ablation threshold is tissue-specific, therebyCan specifically ablate certain tissues (such as myocardium). The ablation threshold of myocardial tissue is lower than that of most other tissues, allowing the ablation of myocardial cells while avoiding damage to adjacent tissues (such as the esophagus or phrenic nerve).

Pulsed Field Ablation for the Treatment of Atrial Fibrillation

3) PFA is extremely fast, often measured in milliseconds or even less. Unlike the operation process of cryoballoon ablation, which involves cooling, rewarming, and verification through an additional mapping catheter, pulsed electric energy is released efficiently with a single release time of 2.5 seconds. Ablation and verification can be completed using a single catheter, significantly shortening the operation time and helping to reduce postoperative recovery time.

4) Repeat mapping at 3 months demonstrated durable ablation effects, with stable pulmonary vein isolation. The long-term effectiveness at the 1-year follow-up met treatment requirements.

Peng Yucheng, Director of the Department of Internal Medicine at Foshan Chan Hospital, stated that the safety and efficacy of pulsed field ablation have been confirmed by multiple clinical trials in Europe and real-world data. A recently published high-quality randomized controlled trial can further demonstrate its effectiveness, particularly for patients with paroxysmal atrial fibrillation who have underlying conditions, cannot tolerate longer surgery times, or have other risk factors.Pulsed Field Ablation is a revolutionary treatment method with higher safety and efficiency.