Pulsed field ablation (PFA) has gained popularity among electrophysiologists, but new real-world data presented at Heart Rhythm 2025 highlight safety concerns linked to this technology. Published in JACC: Clinical Electrophysiology, the study of 871 patients revealed that PFA is associated with a significantly greater risk of myocardial injury compared to traditional radiofrequency (RF) ablation.
Key Findings:
- Myocardial Injury: Elevated levels of high-sensitivity cardiac troponin (cTn), lactate dehydrogenase (LDH), and haptoglobin were observed following PFA, with the damage being dose-dependent.
- Left Atrial Dysfunction: PFA was linked to a more significant decrease in left atrial ejection fraction, suggesting more profound atrial stunning or dysfunction.
- System Differences: Variations in myocardial injury were seen between PFA systems. The Farapulse system, in particular, showed higher levels of cTn and LDH.
- Outcomes: Although clinical adverse events were slightly higher in real-world use (3% vs. 1-2% in studies), post-treatment outcomes were not significantly impacted.
The study underscores the need for more research into the long-term effects of PFA and suggests potential improvements in PFA technology, such as optimized catheter designs and refined dosing protocols, to minimize risks while maintaining clinical efficacy.
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