PFA ablation

Hey guys

I’m 42, have 1 AF episode a month which is slowly getting worse, have normal BMI, good diet etc.

I am considering an ablation, my local cardiologist uses mostly PFA now and does around 250 AF ablations per year. He has done thousands of ablations in his career.

I am a little hesitant to use the new PFA method.

What is the consensus here? are most people happy to use PFA or would you prefer to use the more traditional RF or cryo?

It was trialed between about 2021 and 2023, and approved about the middle of last year, a bit earlier. It was trialed extensively by many EPs internationally and found to be safe and effective. It is limited, at present, to PVI. If your case is more complicated, you'll have to return and be ablated using RF or cryo, whatever your physician feels is best for your case.

In case ablation is still new to you, the failure rate for first ablations runs near 75% across the EP cadre, although there is variation with the very best and most skilled EPs enjoying modestly better success. I was one of those cases that needed a 're-do', but the success rate is quite a bit better for a second ablation because now they're looking for the small, niggling, missed spots and don't have to spend two hours doing what they zapped the first time.

To help situate why a second ablation might be necessary, I went into AF within a week after my first ablation. Six months later, my EP reported after I regained consciousness that he was re-isolating the third vein when my heart began reliably beating in normal sinus rhythm (NSR). The team immediately knew they had just zapped the one tiny gap left in the previous lesions. In fact, he said he didn't even have to cardiovert me back into NSR, something he said he always does before letting his patients out of the cath lab. What I mean to have you understand is that the success of the operation is more due to chance and the skills of the EP, and not due to the method. And PFA is arguably the best method because it IS safer, even if modestly.

Failure rate of 75%? Don’t you mean success rate?

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gloaming
It is limited, at present, to PVI. If your case is more complicated, you'll have to return and be ablated using RF or cryo, whatever your physician feels is best for your case.

Or, ask your EP if they will switch to RF, if necessary, after doing the PVI with PFA. This is only, of course, if there are other trigger areas contributing to your Afib.

Yes, success rate. Brain fart.

Thanks all.

Does anyone know if the top cardiologists in the US are now using primarily PFA for simple PVI ablations? i.e Dr. Natale etc.

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Glen24
Thanks all.

Does anyone know if the top cardiologists in the US are now using primarily PFA for simple PVI ablations? i.e Dr. Natale etc.

My understanding is this is true for Natale and he will switch to RF if needed outside the PVI.

That's probably true of the top EPs in the US, but probably not true of the average EPs. PFA is too new for the training and equipment to have filtered down yet. Both take time and money.

Really appreciate the reply's. Thanks!

My main concerns with PFA at this point in time is the 'recipe' and long term impacts.

Recipe - If it has only been around for a few years, how do they know they have the burn time, voltages etc optimal?

Long term - How do we know that the type of scaring PFA creates is ok for the heart in the longer term and how do we know how durable the scarring will be against Afib over time?