Avoiding Non-Traditional Ablation Risks with Pulse-Field Ablation for Atrial Fibrillation

Cho MS, Lee SR, Black-Maier E, Jackson KP, Friedman DJ, Pokorney SD, Loring Z, Febre J, Piccini JP. Complications associated with pulsed field ablation vs radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm. Published online November 2024:S1547527124035288. https://doi.org/10.1016/j.hrthm.2024.10.063.

Reddy VY, Gerstenfeld EP, Natale A, Whang W, Cuoco FA, Patel C, et al. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation. N Engl J Med. 2023;389(18):1660–71. https://doi.org/10.1056/NEJMoa2307291.

Article  CAS  PubMed  Google Scholar 

Verma A, Haines DE, Boersma LV, Sood N, Natale A, Marchlinski FE, et al. Pulsed field ablation for the treatment of atrial fibrillation: PULSED AF pivotal trial. Circulation. 2023;147(19):1422–32. https://doi.org/10.1161/CIRCULATIONAHA.123.063988.

Article  PubMed  PubMed Central  Google Scholar 

Anter E, Mansour M, Nair DG, Sharma D, Taigen TL, Neuzil P, et al. Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial. Nat Med. 2024;30(8):2303–10. https://doi.org/10.1038/s41591-024-03022-6.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Reddy VY, Calkins H, Mansour M, Wazni O, Di Biase L, Bahu M, et al. Pulsed field ablation to treat paroxysmal atrial fibrillation: safety and effectiveness in the AdmIRE pivotal trial. Circulation. 2024;150(15):1174–86. https://doi.org/10.1161/CIRCULATIONAHA.124.070333.

Article  PubMed  PubMed Central  Google Scholar 

Zimmermann U, Pilwat G, Riemann F. Preparation of erythrocyte ghosts by dielectric breakdown of the cell membrane. Biochim Biophys Acta. 1975;375(2):209–19. https://doi.org/10.1016/0005-2736(75)90189-3.

Article  CAS  PubMed  Google Scholar 

Venier S, Vaxelaire N, Jacon P, Carabelli A, Desbiolles A, Garban F, et al. Severe acute kidney injury related to haemolysis after pulsed field ablation for atrial fibrillation. Europace. 2023;26(1):euad371. https://doi.org/10.1093/europace/euad371.

Article  PubMed  Google Scholar 

Popa MA, Venier S, Menè R, Della Rocca DG, Sacher F, Derval N, et al. Characterization and clinical significance of hemolysis after pulsed field ablation for atrial fibrillation: results of a multicenter analysis. Circ Arrhythm Electrophysiol. 2024;17(10):e012732. https://doi.org/10.1161/CIRCEP.124.012732.

Article  CAS  PubMed  Google Scholar 

Van Avondt K, Nur E, Zeerleder S. Mechanisms of haemolysis-induced kidney injury. Nat Rev Nephrol. 2019;15(11):671–92. https://doi.org/10.1038/s41581-019-0181-0.

Article  CAS  PubMed  Google Scholar 

La Fazia VM, Mohanty S, Torlapati PG, Gianni C, Della Rocca DG, Bode W, et al. Hydration to prevent kidney injury after pulsed field ablation. JACC Clin Electrophysiol. 2025;11(3):599–601. https://doi.org/10.1016/j.jacep.2024.11.001.

Article  PubMed  Google Scholar 

Kubota K, Egi M, Mizobuchi S. Haptoglobin administration in cardiovascular surgery patients: its association with the risk of postoperative acute kidney injury. Anesth Analg. 2017;124(6):1771–6. https://doi.org/10.1213/ANE.0000000000002093.

Article  CAS  PubMed  Google Scholar 

Ramirez DA, Garrott K, Garlitski A, Koop B. Coronary spasm due to pulsed field ablation: A state-of-the-art review. Pacing Clin Electrophis. Published online November 4, 2024;pace.15101. https://doi.org/10.1111/pace.15101.

Luther V, Chiong J, James C, Modi S, Gupta D, Hung J. Diffuse right coronary artery spasm occurring 45 minutes after pulsed field ablation for atrial fibrillation. Heart Rhythm. 2025. https://doi.org/10.1016/j.hrthm.2025.03.1978.

Article  PubMed  Google Scholar 

Menè R, Boveda S, Della Rocca DG, Sousonis V, Vetta G, Zeriouh S, Doundoulakis I, Betancur A, Benadel M, Combes N, Sarkozy A, Chierchia GB, De Asmundis C, Albenque JP, Combes S. Efficacy of intravenous nitrates for the prevention of coronary artery spasm during pulsed field ablation of the Mitral Isthmus. Circ: Arrhythmia Electrophysiol. 2024;17(1). https://doi.org/10.1161/CIRCEP.123.012426.

Malyshev Y, Neuzil P, Petru J, Funasako M, Hala P, Kopriva K, et al. Nitroglycerin to ameliorate coronary artery spasm during focal pulsed-field ablation for atrial fibrillation. JACC Clin Electrophysiol. 2024;10(5):885–96. https://doi.org/10.1016/j.jacep.2023.12.015.

Article  PubMed  Google Scholar 

Higuchi S, Im SI, Stillson C, Buck ED, Jerrell S, Schneider CW, et al. Effect of epicardial pulsed field ablation directly on coronary arteries. JACC Clin Electrophysiol. 2022;8(12):1486–96. https://doi.org/10.1016/j.jacep.2022.09.003.

Article  PubMed  Google Scholar 

Tam MTK, Chan JYS, Chan CP, Wu EB, Lai A, Au ACK, et al. Effect of pulsed-field ablation on human coronary arteries. JACC Clin Electrophysiol. 2025. https://doi.org/10.1016/j.jacep.2025.03.014.

Article  PubMed  Google Scholar 

Vetta G, Della Rocca DG, Magnocavallo M, Richard-Vitton R, Almorad A, Betancur A, Sorgente A, Polselli M, Marcon L, Mohanty S, Del Monte A, Lombardo I, Pannone L, Mouram S, Stroker E, Gianni C, La Fazia VM, Bianchi S, Doundoulakis I, Overeinder I, Audiat C, Nakasone K, Bala G, Combes S, Sarkozy A, Sieira J, Boveda S, Rossi P, Natale A, De Asmundis C, Chierchia GB, Eltsov I, Scacciavillani R, Berisha E. Efficacy and drug-related complications of anticholinergic drugs for vagal reaction prevention during pulsed field ablation. JACC: Clin Electrophysiol. Published online April 2025:S2405500X25002725. https://doi.org/10.1016/j.jacep.2025.04.015.

Chehirlian L, Koutbi L, Mancini J, Hourdain J, Robin-Vitton R, Wilkin M, Deharo JC, Maille B, Franceschi F. High incidence of phrenic nerve injury in patients undergoing pulsed field ablation for atrial fibrillation. Heart Rhythm. Published online August 9, 2025. https://doi.org/10.1016/j.hrthm.2025.08.010.

Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, et al. Safety and effectiveness of pulsed field ablation to treat atrial fibrillation: one-year outcomes from the MANIFEST-PF registry. Circulation. 2023;148(1):35–46. https://doi.org/10.1161/CIRCULATIONAHA.123.064959.

Article  CAS  PubMed  Google Scholar 

Nies M, Koruth JS, Mlček M, Petru J, Tibenská VC, Watanabe K, Královec Š, Hala P, Tejkl L, Neuzil P, Reddy VY. Is the esophagus spared during pulsed field ablation? Early histopathology and in vivo esophageal retraction. Heart Rhythm. Published online June 2025:S1547527125026128. https://doi.org/10.1016/j.hrthm.2025.06.033.

Gunawardene MA, Middeldorp M, Pape UF, Maasberg S, Hartmann J, Dickow J, et al. Esophageal endoscopic findings after pulmonary vein and posterior wall isolation using pulsed field ablation: results from the Eso-PFA study. Europace. 2025;27(8):euaf133. https://doi.org/10.1093/europace/euaf133.

Article  PubMed  PubMed Central  Google Scholar 

Mahnič-Kalamiza S, Miklavčič D, Lombergar P, Mikuž B, Mattison LM, Sigg DC, et al. Elucidating the mechanisms of microbubble formation in intracardiac pulsed field ablation. Electrochim Acta. 2024;497:144550. https://doi.org/10.1016/j.electacta.2024.144550.

Article  CAS  Google Scholar 

Sánchez-Gómez JM, Ortiz-Fernández Á, Soler-Martínez J, Gabaldón-Pérez A, Iraola-Viana D, Martínez-Brotons Á, Bondanza-Saavedra L, Domínguez-Mafé E, Redondo-Nieto L, Picazo-Campos P, García-López S, Faubel-Subiñas R, Sanchis-Fores J, Ruiz-Granell R, Ferrero De Loma-Osorio Á. Incidence of brain lesions following pulsed field ablation for atrial fibrillation. Heart Rhythm. Published online July 2025:S1547527125001894. https://doi.org/10.1016/j.hrthm.2025.02.020.

Calvert P, Kollias G, Pürerfellner H, Narasimhan C, Osorio J, Lip GYH, et al. Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review. Europace. 2023;25(6):euad151. https://doi.org/10.1093/europace/euad151.

Article  PubMed  PubMed Central  Google Scholar 

Comments (0)

No login
gif