Pulsed Field Ablation: What Every Clinician Should Know-Pulsed Field Ablation: What Every Clinician Should Know

Video Transcription

Video Summary

The session at HRS 2025 in San Diego focused on Pulse Field Ablation (PFA), chaired by Maria Terricabras from Sunnybrook Health Sciences Center, who welcomed four speakers to present on various aspects of PFA. The discussions centered around optimizing PFA parameters, minimizing skeletal muscle recruitment, and the challenges encountered with different PFA systems.<br /><br />Atul Verma from McGill University presented on the critical role of pulse width in PFA, emphasizing its impact on lesion depth and muscle stimulation. He highlighted the precise science behind adjusting pulse width and the challenges in achieving effective tissue ablation without excessive musculoskeletal stimulation.<br /><br />Damian McLoughlin explored the thermal effects and micro-bubble formation related to PFA. He discussed the origins of bubbles during PFA, emphasizing the importance of understanding waveforms and pulse parameters in mitigating incidental heating and bubble production.<br /><br />Debbie Nair addressed hemolysis in relation to PFA, noting its dependence on system-specific parameters. She underscored the risk of hemolysis leading to renal injury and other complications, stressing the importance of understanding device-specific designs and pulse deliveries to mitigate such risks.<br /><br />Quim Castellví examined the differences between microsecond versus nanosecond pulses, discussing the advantages of nanosecond pulses in reducing muscle stimulation and enhancing apoptosis. However, he noted challenges in implementing pure nanosecond pulses due to technological constraints and compatibility issues.<br /><br />The session concluded with a discussion on selecting the appropriate PFA system based on factors like thermal signature and hemolysis risks. The consensus was to choose systems with the lowest thermal effects and to consider patient-specific factors like renal function when selecting a device.

Keywords

Pulse Field Ablation

PFA parameters

muscle recruitment

pulse width

thermal effects

micro-bubble formation

hemolysis

nanosecond pulses

apoptosis

device selection