Pulsed Field Ablation

What is pulsed field ablation?

Pulsed field ablation is a procedure to treat atrial fibrillation (AFib) using electricity to zap and destroy areas of heart tissue where abnormal heart rhythms arise. Your healthcare provider may suggest this procedure if medicines haven’t worked for AFib.

Compared to older methods, this approach is very careful in selecting the right areas of tissue to target and less likely to damage tissues nearby. Because of this and other benefits, providers are using this approach more often than ever before. They’re also studying its possible use for abnormal heart rhythms in the lower heart chambers.

The U.S. Food and Drug Administration approved the first pulsed field ablation device in 2023.

How should I prepare for this procedure?

Before pulsed field ablation for AFib, you may need to:

• Ask a friend or relative to drive you to and from the hospital
• Stop taking certain medicines (like blood thinners) before your procedure (only if your provider tells you to)
• Stop eating or drinking the night before your procedure (usually after midnight)

On the day of the procedure, wear comfortable clothes. You should also leave jewelry and other valuable items at home.

What happens during pulsed field ablation?

A pulsed field ablation procedure takes an average of two hours or less. During the procedure, your healthcare team will:

1. Shave, clean and numb your groin area
2. Give you anesthesia so you’ll be in a deep sleep and won’t feel pain
3. Give you heparin (a blood thinner) to prevent blood clots
4. Make a tiny puncture in the skin in your groin area
5. Put a sheath (small tube) into the puncture
6. Put a catheter through the sheath and into your femoral vein
7. Work the catheter up to your heart
8. Use X-ray images (fluoroscopy), sound waves or 3D mapping to guide the catheter to the correct area
9. Use the catheter to create an electric field that damages unwanted tissue
10. Remove the catheter and sheath
11. Close the puncture wound in your groin

What are the potential benefits and risks of this procedure?

A pulsed field ablation procedure isn’t open surgery. It’s minimally invasive, lower risk and usually has a same-day recovery and discharge. It can help keep AFib from coming back in most people.

Benefits of pulsed field ablation over other ablation approaches include:

• Quicker procedure (takes less than one minute total to send the pulses)
• Low complication rate
• Limited damage to nearby tissues, like your esophagus and phrenic nerve
• Less risk of making your pulmonary vein narrow (stenosis)

No procedure is without side effects and risks. Providers use the utmost caution to avoid side effects and quickly intervene when they rarely occur.

With this approach, you may have exposure to X-rays (fluoroscopy) for longer than you would with heat ablation. Possible pulsed field ablation side effects or risks​ include:

• Heart palpitations
• Shortness of breath
• Fatigue
• Bruises around the incision site
• Low heart rate (bradycardia)
• Stunned phrenic nerve, which is reversible
• Excess fluid around your heart (pericardial effusion)
• Stroke

What happens after this procedure?

After pulsed field ablation, you’ll need to spend three to six hours resting in bed. You’ll likely go home the same day or the next day.

Before you go home, you’ll probably start taking blood thinners again to prevent blood clots. You can expect to take antiarrhythmic medicines to prevent AFib until the ablation takes effect. This may be a few months.

You’ll have follow-up visits with your healthcare team after one, three and six months. Then you’ll see your team every six months. These visits may include an EKG test to check for abnormal heart rhythms.

When should I call my healthcare provider?

If you have arm weakness or face drooping, call 911 or your local emergency number. These stroke symptoms need care right away.

After your procedure, contact your provider if you have:

• New symptoms of atrial fibrillation
• Bleeding, swelling or a lump around the wound site in your groin
• Nausea or vomiting
• Lightheadedness or dizziness
• Pain, tingling or numbness in your leg
• Chest pain