Pulsed field ablation – A novel treatment for heart rhythm disorders

Pulsed field ablation – A novel treatment for heart rhythm disorders

Commonest form of ablation of heart rhythm disorders uses radiofrequency current delivered through a catheter to produce localised heating of cells and damage of the abnormal circuit of electrical activity within the heart. Electrode catheters are small wires introduced through the blood vessels of the groin or neck into the heart. Radiofrequency current is the type of current generated in mobile phones for transmission of messages. Pulsed-field ablation is a novel modality which employs a train of microsecond duration high amplitude electrical pulses that ablate the abnormal focus by electroporation of the muscle cell membrane without measurable local heating.

Success of pulse field ablation depends on the nearness of the electrode to the target cells, though not necessarily on contact. An important feature of pulse field ablation is its specificity for the type of cells. While heart muscle cells are susceptible to irreversible injury, food pipe, nerve to the diaphragm, and blood vessels of the heart are relatively resistant. This improves the safety during ablation by preventing collateral damage. Procedure time is reduced due to the rapid achievement of ablation.

Atrial fibrillation is a fast irregular rhythm originating from the upper chambers of the heart. Two important potential complications during conventional radiofrequency catheter ablation of atrial fibrillation are injury to the food pipe due to the heating and damage to the nerve to diaphragm. Both these structures are in close contact with left upper chamber of the heart making them susceptible to collateral damage. Diaphragm is the big muscle separating the chest and tummy. It is very important for breathing. Pulse field ablation avoids damage to these important nearby structures.