Fluoroless Pulsed Field Ablation of Atrial Fibrillation

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Mansour Razminia, MD, a cardiac electrophysiologist at Northwestern Medicine, discusses the innovative technique of fluoroless pulsed field ablation (PFA) for treating atrial fibrillation. He explains how this ultra-rapid electrical field safely disrupts targeted cardiac tissues, leading to effective treatment outcomes with minimal collateral damage. Dr. Razminia also highlights Northwestern Medicine's recent success with the procedure and introduces the retrospective MANIFEST-US survey designed to assess the acute efficacy and safety of the FARAWAVE™ PFA Catheter.

 

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New Procedures Offer Alternatives to Long-Term Blood Thinners for AFib Patients​

Doctors in Maine are using American Heart Month to raise awareness about new treatments that could reduce the need for long-term medications for atrial fibrillation (AFib). AFib is an irregular heart rhythm that increases the risk of blood clots, strokes, and other heart complications.

Pulsed Field Ablation: A Safer Alternative​

Central Maine Medical Center (CMMC) was the first in the state to offer pulsed field ablation, a procedure that uses electrical pulses to disable AFib triggers. Doctors highlight that this method is safer than traditional treatments and can reduce a patient’s dependence on blood thinners.

While blood thinners are the first-line treatment for AFib, they come with an increased risk of bleeding. One patient shared their experience:

"The biggest benefit is stroke protection without the need for blood thinners. I had a simple, in-and-out day procedure—if that’s all it takes to stop taking blood thinners, why not?"

Implant Procedure to Prevent Blood Clots​

Another available treatment involves a permanent implant that prevents blood clots from leaving the heart, offering further protection against stroke.

Where to Find These Treatments​

MaineHealth, Northern Light Health, and CMMC all provide these advanced AFib treatments, giving patients more options beyond long-term medication.

 

I got an ablation three weeks ago due to PVC's (28% burden).

Premature ventricular contractions (PVCs) are extra heartbeats originating from the ventricles, disrupting the normal heart rhythm. While often benign, frequent PVCs can lead to symptoms or complications such as cardiomyopathy (heart muscle weakening). Catheter ablation is a treatment option for symptomatic or high-burden PVCs, especially when other interventions fail.

Understanding PVCs
PVCs occur when the ventricles contract prematurely, creating an irregular heartbeat pattern: a normal beat, followed by an extra beat (PVC), a pause, and then a stronger-than-normal beat. This can feel like a skipped beat, fluttering, or a pounding sensation in the chest. 17. Common triggers include stress, caffeine, alcohol, electrolyte imbalances, and underlying heart disease.69.

While PVCs are common and often harmless in healthy individuals, frequent PVCs (e.g., >10-20% of total heartbeats) can impair heart function and lead to cardiomyopathy or arrhythmias. Symptoms may include palpitations, fatigue, dizziness, or shortness of breath.127.

Treatment Options
Lifestyle Changes and Medications
For mild cases or infrequent PVCs:

Lifestyle modifications like reducing caffeine or alcohol intake and managing stress may help.

Medications such as beta-blockers or calcium channel blockers are first-line treatments for symptomatic PVCs.

Catheter Ablation
Catheter ablation is a minimally invasive procedure used for patients with frequent PVCs (>10% burden) or those unresponsive to medications. It involves:

Inserting a catheter through blood vessels to the heart.

Mapping the site of abnormal electrical activity.

Using radiofrequency energy to destroy (ablate) the tissue causing the PVCs45.

Efficacy: Ablation can eliminate PVCs in up to 85% of patients and improve left ventricular function in cases of PVC-induced cardiomyopathy8. It is particularly effective for localized PVC foci.

Risks: While generally safe, risks include bleeding, infection, vascular complications, or damage to cardiac structures. Rarely, more serious complications like heart block or pericardial effusion may occur58.

Advanced Techniques
For refractory cases where standard ablation fails (e.g., deep intramural foci), newer methods like infusion needle ablation (INA) have shown promise. INA delivers radiofrequency energy deeper into the myocardium and has demonstrated significant reductions in PVC burden with acceptable safety profiles8.

When to Consider Ablation
Ablation is recommended for:

Symptomatic patients with frequent PVCs affecting quality of life.

Patients with PVC-induced cardiomyopathy.

Those who fail medical therapy or prefer an alternative to long-term medication use 258.

Conclusion
While many PVCs are benign and require no treatment, frequent or symptomatic cases may necessitate intervention. Catheter ablation is an effective and increasingly safe option for managing high-burden PVCs or associated cardiomyopathy. Patients should consult a cardiologist specializing in electrophysiology to determine the best approach based on their symptoms, PVC burden, and overall health.

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[2] Evaluation and Management of Premature Ventricular Complexes - PubMed
[3] https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042434
[4] Using Ablation to Treat Premature Ventricular Contractions - Oklahoma Heart Hospital
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[6] Premature Ventricular Contractions (PVCs) and Premature Atrial Contractions (PACs) | Frankel Cardiovascular Center | Michigan Medicine
[7] Premature Ventricular Contractions (PVCs)
[8] https://www.ahajournals.org/doi/10.1161/CIRCEP.121.010020
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[27] https://www.ohsu.edu/sites/default/files/2019-02/CAR-21469653-PVC-FACT-v7-1-_WEB.pdf
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[29] https://pmc.ncbi.nlm.nih.gov/articles/PMC8183869/
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