Interventional procedure overview of pulsed field ablation for atrial fibrillation

What the procedure involves

PFA is a catheter ablation technique that uses electrical energy to destroy the heart cells that transmit abnormal electrical impulses. In the NHS, the procedure is usually done under GA but deep sedation is often used in other countries. As in other catheter ablation procedures for AF, a catheter is inserted via the femoral vein and advanced into the left atrium through a trans‑septal puncture. The PFA catheter delivers rapid, high-voltage pulsed electrical energy to the tissue it is applied to. This causes pores to form in myocardial cells, so the cells die (irreversible electroporation). Most commonly, PFA is used for isolation of abnormal electrical activity transmitted through the PV cells at the entrance to the left atrium, but it can be used on other structures like the left atrial posterior wall. The aim is targeted destruction and scar formation in the tissue it is applied to, to disrupt the transmission of abnormal electrical impulses that cause AF, whilst avoiding damage to surrounding tissues such as nerves and blood vessels.