Pulsed field ablation

Pulsed field ablation (PFA) is a non-thermal (not using extreme heat or cold) method of biological ablation (removal of structure or functionality) utilizing high-amplitude pulsed (microsecond duration) electric fields to create irreversible electroporation in tissues.[1] [2] It is used most widely to treat tumors (cancer) or cardiac arrhythmias.[3]

Background

Atrial fibrillation frequently results from bursts of tachycardia that originate in muscle bundles extending from the atrium to the pulmonary veins.[4] Pulmonary vein isolation ablation technology has used thermal methods (radiofrequency ablation or, less often, cryoablation) to destroy pulmonary vein cells.[5] As with thermal methods of ablation, in pulsed field ablation, a thin, flexible tube (catheter) is inserted into a blood vessel in the groin and threaded up into the heart to ablate the areas of the pulmonary vein causing excessively rapid electrical signals.[6]

Advantages

A major reason for recurrence of atrial fibrillation after ablation has been the belief of electrical pulmonary vein reconnection, which has not been seen for PFA.[7] In one study, atrial fibrillation recurrence in the thermal ablation group was 39% compared to 11% in the PFA group.[8] PFA can achieve pulmonary vein isolation faster than other ablation methods.[1][8] Compared to radiofrequency ablation, PFA produces lesions of greater uniformity.[5]

Safety

Cell death following PFA is usually due to apoptosis, which is a far less damaging and inflammatory form of cell death than necrosis.[1][3] In contrast to thermal methods of ablation, PFA specifically kills cardiomyocytes (cardiac muscle cells) without injuring surrounding tissues.[1][2] Thermal ablation methods can damage the esophagus, phrenic nerve, and coronary vessels (as high as 5% [8]), which are spared by PFA.[1] One study showed an overall complication rate of 0.7% for PFA and no occurrence of phrenic nerve, esophageal, or pulmonary vein injury.[9]

Challenges

Because PFA is a relatively newer ablation technique, there is a lack of uniformity in the parameters for its delivery.[8] Better standardization could help reduce instances of coronary artery spasm and pulmonary artery hemorrhage, which can occur.[8] The equipment cost and lack of specialized training have limited the widespread use of PFA, making it unavailable to many patients.[8]

Recent (2024) comparisons of PFA with thermal methods have shown reduced time spent in surgery, but no superiority in safety and no better reduction of atrial fibrillation.[10] When used in areas other than the pulmonary vein, injuries have been seen.[10]

References

  1. ^ a b c d e Bradley CJ, Haines DE (2020). "Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation". Journal of Cardiovascular Electrophysiology. 31 (8): 2136–2147. doi:10.1111/jce.14414. PMID 32107812.
  2. ^ a b Schaack D, Schmidt B, Chun KJ (2023). "Pulsed Field Ablation for Atrial Fibrillation". Arrhythmia & Electrophysiology Review. 12: e11. doi:10.15420/aer.2022.45. PMC 10326665. PMID 37427302.
  3. ^ a b Napotnik TB, Polajžer T, Miklavčič D (2021). "Cell death due to electroporation - A review". Bioelectrochemistry. 141: 107871. doi:10.1016/j.bioelechem.2021.107871. PMID 34147013.
  4. ^ McGarry TJ, Narayan SM (2012). "The anatomical basis of pulmonary vein reconnection after ablation for atrial fibrillation: wounds that never felt a scar?". Journal of the American College of Cardiology. 50 (10): 939–941. doi:10.1016/j.jacc.2011.11.032. PMC 3393092. PMID 22381430.
  5. ^ a b Matos CD, Hoyos C, Osorio J (2023). "Pulsed Field Ablation of Atrial Fibrillation: A Comprehensive Review". Reviews in Cardiovascular Medicine. 24 (11): 337. doi:10.31083/j.rcm2411337. PMC 11272841. PMID 39076426.
  6. ^ Ames A, Stevenson WG (206). "Catheter ablation of atrial fibrillation". Circulation. 113 (13): e666-8. doi:10.1161/CIRCULATIONAHA.105.613083. PMID 16585395.
  7. ^ Reddy VY, Neuzil P, Jais P (2019). "Pulsed Field Ablation for Pulmonary Vein Isolation in Atrial Fibrillation". Journal of the American College of Cardiology. 74 (3): 15–326. doi:10.1016/j.jacc.2019.04.021. PMID 31085321.
  8. ^ a b c d e f Iyengar SK, Iyengar S, Srivathsan K (2023). "The promise of pulsed field ablation and the challenges ahead". Frontiers in Cardiovascular Medicine. 10: 1235317. doi:10.3389/fcvm.2023.1235317. PMC 10627215. PMID 37937293.
  9. ^ Verma A, Haines DE, DeLurgio DB (2023). "Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial". Circulation. 147 (19): 422–1432. doi:10.1161/CIRCULATIONAHA.123.063988. PMC 10158608. PMID 36877118.
  10. ^ a b Deering TF, Bunch TJ, Smith AM (2024). "Pulsed field ablation: A promise with future broad-based applicability or a pause needing further analysis-Is catheter ablation at a crossroads? A critical appraisal of the new challenger-pulsed field ablation". Heart Rhythm. 21 (8): 1242–1244. doi:10.1016/j.hrthm.2024.03.1763. PMID 38548125.

Read other articles:

The Needles (Arizona)

Rock formation in the Havasu National Wildlife Refuge, Arizona For other uses, see The Needles (disambiguation). The Needles, at Topock Gorge from the northwest looking down the Colorado River, April 2006. The Needles are a distinctive group of rock pinnacles, mountain peaks adjacent to the Topock Gorge, and the Colorado River on the northwestern extreme of the Mojave Mountains within the Havasu National Wildlife Refuge in Mohave County, Arizona, United States.[1] They range from 1207...

 

قائمة الحاصلين على جائزة نوبل

شعار جائزة نوبل. تمنُح جوائز نوبل (بالسويدية: Nobelpriset، وبالنرويجية: Nobelprisen) كل عام من قبل الأكاديمية الملكية السويدية للعلوم والأكاديمية السويدية ومعهد كارولنسكا ولجنة نوبل النرويجية، وذلك للأفراد والمنظمات ذوي الإسهامات البارزة في مجالات الكيمياء والفيزياء والأدب والسلا...

 

Kim Jae-ryong

Ini adalah nama Korea; marganya adalah Kim. Kim Jae-ryong김재룡 Perdana Menteri Korea Utara ke-12Masa jabatan11 April 2019 – 13 Agustus 2020Pemimpin TertinggiKim Jong-un PendahuluPak Pong-juPenggantiKim Tok-hunAnggota Majelis Tertinggi Rakyat untuk HuichonPetahanaMulai menjabat 10 Maret 2019 PendahuluCho Jae-yongPenggantiPetahanaSekretaris Komite Partai Buruh Korea Provinsi ChagangMasa jabatan2016–2019 Pendahulu?PenggantiKang Bong-hun Informasi pribadiPartai politikPartai ...

Science, technology, engineering, and mathematics

Group of academic disciplines STEM redirects here. For other uses, see Stem (disambiguation). A high school student explains her engineering project to a judge in Sacramento, California, United States (2015). Science, technology, engineering, and mathematics (STEM) is an umbrella term used to group together the distinct but related technical disciplines of science, technology, engineering, and mathematics. The term is typically used in the context of education policy or curriculum choices in ...

 

Élections cantonales de 2004 dans les Hauts-de-Seine

2001 2008 Élections cantonales de 2004 dans les Hauts-de-Seine 23 des 45 cantons des Hauts-de-Seine 21 et 28 mars 2004 Type d’élection Élections cantonales PCF : sièges PS : sièges DVG : siège DVD : siège NC : sièges UMP : sièges modifier - modifier le code - voir Wikidata  Les élections cantonales ont eu lieu les 21 et 28 mars 2004. Lors de ces élections, 23 des 45 cantons des Hauts-de-Seine sont renouvelés. Elles ont vu la reconduction ...

 

Sydney Gay and Lesbian Holocaust Memorial

Gay and Lesbian Holocaust Memorial Sydney Gay and Lesbian Memorial The Sydney Gay and Lesbian Holocaust Memorial Project was founded by a group of community activists. Over the years they raised funds and decided, with South Sydney City Council, on the site at Green Park in Darlinghurst, in Sydney, Australia. Darlinghurst is considered the heart of Sydney's gay and lesbian population. Green Park is adjacent to the Sydney Jewish Museum, which ensures that the memorial retains its historic mea...

Géographie de l'Algérie

Géographie de l'Algérie Continent  Afrique Région Afrique du Nord Coordonnées 28° N, 3° E Superficie 10e rang mondial2 381 741 km2Terres : 100 % Eau : 0 % Côtes 2 148 km Frontières Total : 6 343 : Libye 982 km, Mali 1 376 km, Mauritanie 463 km, Maroc 1 559 km, Niger 956 km, Sahara occidental 42 km, Tunisie 965 km[1] Altitude maximale Tahat (2 918 m) Plus long cours d’e...

 

Don Barksdale

Questa voce sull'argomento cestisti statunitensi è solo un abbozzo. Contribuisci a migliorarla secondo le convenzioni di Wikipedia. Segui i suggerimenti del progetto di riferimento. Don Barksdale Nazionalità  Stati Uniti Altezza 198 cm Peso 91 kg Pallacanestro Ruolo Ala grande Termine carriera 1955 Hall of fame Naismith Hall of Fame (2012) Carriera Giovanili Berkeley High School1940-1942Marin Junior College1942-1943 UCLA Bruins1946-1947 UCLA Bruins Squadre di club ...

 

Mfiondu Kabengele

Mfiondu Kabengele Nazionalità  Canada Altezza 208 cm Peso 115 kg Pallacanestro Ruolo Ala grande / centro Squadra  Reyer Venezia Carriera Giovanili Corpus Christi Catholic School2015-2016Don Bosco Institute2016-2019 Fl. State Seminoles Squadre di club 2019-2021 L.A. Clippers35 (69)2019-2020→  A.C. Clippers27 (506)2021 Cleveland Cavaliers16 (68)2021-2022 R.G.V. Vipers25 (437)2022-2023 Boston Celtics4 (6)2022-2023→  Maine Celtics27 (540)2023...

Shitao

Shi Tao, Guru Shi Menanam Pinus, kira-kira tahun 1674, tinta dan warna di atas kertas. Museum Istana Nasional Shi Tao (Hanzi sederhana: 石涛; Hanzi tradisional: 石濤; Pinyin: Shí Tāo; Wade–Giles: Shih T'ao); (1642–1718), terlahir sebagai Zhu Ruoji (朱若極) ialah seorang pelukis lanskap dan penyair Cina pada permulaan zaman Dinasti Qing (1644–1911).[1] Dilahirkan di Kabupaten Quanzhou di Provinsi Guangxi, Shi Tao ialah anggota istana kerajaan Dinasti Ming...

 

Elecciones presidenciales de Estados Unidos de 1988

← 1984 •  • 1992 → Elecciones Presidenciales de Estados Unidos de 1988 Fecha Martes 8 de noviembre de 1988 Tipo Presidencial Demografía electoral Población &&&&&&0 245 057 000,&&&&&0245 057 000 Hab. registrados &&&&&&0 118 589 000,&&&&&0118 589 000 Votantes &&&&&&0 110 826 000,&...

 

Pope Sixtus V

Head of the Catholic Church from 1585 to 1590 PopeSixtus VBishop of RomeSixtus V depicted in an anonymous 17th century painting, exhibited in the Albi CathedralChurchCatholic ChurchPapacy began24 April 1585Papacy ended27 August 1590PredecessorGregory XIIISuccessorUrban VIIOrdersOrdination1547Consecration12 January 1567by Antonio LauroCreated cardinal17 May 1570by Pius VPersonal detailsBornFelice Piergentile, then Felice Peretti(1521-12-13)13 December 1521Grottammare, Papal StatesDied27 A...

Hermione Gingold

English actress (1897–1987) Hermione GingoldGingold in 1973, by Allan WarrenBornHermione Ferdinanda Gingold(1897-12-09)9 December 1897Maida Vale, London, EnglandDied24 May 1987(1987-05-24) (aged 89)New York City, U.S.Resting placeForest Lawn Memorial Park Glendale, California, U.S.OccupationActressYears active1909–1984Spouses Michael Joseph ​ ​(m. 1918; div. 1926)​ Eric Maschwitz ​ ​(m. 1926; div.&#...

 

Державний комітет телебачення і радіомовлення України

Державний комітет телебачення і радіомовлення України (Держкомтелерадіо) Приміщення комітетуЗагальна інформаціяКраїна  УкраїнаДата створення 2003Керівне відомство Кабінет Міністрів УкраїниРічний бюджет 1 964 898 500 ₴[1]Голова Олег НаливайкоПідвідомчі ор...

 

2016年美國總統選舉

2016年美國總統選舉 ← 2012 2016年11月8日 2020 → 538個選舉人團席位獲勝需270票民意調查投票率55.7%[1][2] ▲ 0.8 %   获提名人 唐納·川普 希拉莉·克林頓 政党 共和黨 民主党 家鄉州 紐約州 紐約州 竞选搭档 迈克·彭斯 蒂姆·凱恩 选举人票 304[3][4][註 1] 227[5] 胜出州/省 30 + 緬-2 20 + DC 民選得票 62,984,828[6] 65,853,514[6]...

Venturi Racing

For the team that competed as Venturi in the 1992 Formula One World Championship, see Larrousse. Monegasque Formula E team ROKiT Venturi RacingFounded2013Founder(s)Gildo Pallanca PastorFolded2022 (2022)Former seriesFormula EWebsitewww.venturiracing.com Venturi Racing[1] (formerly Venturi Formula E Team[2]) was a Monegasque motor racing team controlled by Scott Swid (Chairman and principal owner) and José M Aznar Botella. The team competed in the FIA Formula E World Champ...

 

Battle of Ballantyne Pier

1935 labor conflict in Vancouver, Canada This article includes a list of references, related reading, or external links, but its sources remain unclear because it lacks inline citations. Please help improve this article by introducing more precise citations. (June 2012) (Learn how and when to remove this message) Part of the series onHistory of Vancouver History Gastown(1867–1886) Granville(1870–1886) City of Vancouver(1886–present) Events Great Vancouver Fire 1886Komagata Maru incident...

 

Ditlev Gothard Monrad

Danish PoliticianDitlev Gothard MonradCouncil President of DenmarkIn office31 December 1863 – 11 July 1864MonarchChristian IXPreceded byCarl Christian HallSucceeded byChristian Albrecht Bluhme Personal detailsBorn(1811-11-24)24 November 1811Copenhagen, DenmarkDied28 March 1887(1887-03-28) (aged 75)Nykøbing Falster, DenmarkPolitical partyNational Liberal Party Ditlev Gothard Monrad (24 November 1811 – 28 March 1887) was a Danish politician and bishop, and a founding fath...

Équipe cycliste Decathlon AG2R La Mondiale

Decathlon-AG2R La MondialeLogo de l'équipe depuis 2024.InformationsStatuts Équipe pro (1992-1998)Groupe Sportif I (d) (1997-2000)Groupe Sportif II (d) (2001)Groupe Sportif I (d) (2002-2004)continentale pro (2005)UCI ProTeam (2006-2014)UCI WorldTeam (depuis 2015)Codes UCI A2R (de 2000 à 2007), ALM (de 2008 à 2020), ACT (de 2021 à 2023) et DAT (depuis 2024)Discipline Cyclisme sur routePays  FranceCréation 1992Saisons 33Budget 26 millions d'euros (2024)[1]Marque de cycles Routens (199...

 

Geometri hingga

Bidang afin hingga dengan orde 2, berisi 4 titik dan 6 garis. Garis yang warnanya sama disebut paralel. Pusat dari gambar ini bukan merupakan sebuah titik dari bidang afin, jadi kedua garis hijau tidak berpotongan. Geometri hingga adalah sistem geometri mana pun yang terdiri dari titik-titik yang banyaknya berhingga. Geometri Euklides yang biasa dikenal bukan merupakan geometri hingga, karena garis Euklides mengandung titik yang banyak tidak terhingga. Geometri yang berdasar kepada grafika ya...