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2025 AF Symposium
Live Case Transmission: Nanosecond Pulsed Field Ablation
Dr. Petr Neuzil
In a Live Case Transmission (Session 6), Dr. Petr Neuzil at Homolka Hospital, Prague, Czech Hospital gave a presentation on “Nanosecond Pulsed Field Ablation for Atrial Fibrillation.”
While Dr. Neuzil performed the ablation in Prague, Dr. Vivek Reddy of Mount Sinai Medical Center was in Boston at the AF Symposium. He commented on and assisted Dr. Neuzil ‘s presentation.
Special Catheter for Nanosecond Pulsed Field Ablation (nsPFA)
Dr. Neuzil began by describing the innovative nanosecond Pulsed Field Ablation catheter to be used on his patient who had been in A-Fib for a year.
It is composed of two circular rings, one inner and one outer with 12 electrodes. [We could see that this catheter is very flexible and soft. It easily conformed to the patient’s anatomy thus allowing for regional ablation.]
Graphics source: Reddy, V. Y. , et al. First-In-Human Clinical Experience of Pulse Field Ablation Using Nanosecond Pulses to Treat Atrial Fibrillation.
Dr. Neuzil used the term “gentle” to describe its functioning.
It produced a 360° field around the area of Pulsed Field application, like “single shot” ablation. He described the configuration he was using as “mushroom”, while it can also be configured in an umbrella (flower) pattern.
Nanosecond PFA Ablation
Nanosecond pulsed field ablation (nsPFA) is a novel cardiac ablation technique using ultra-short, high-amplitude electrical pulses to ablate heart cells significantly reducing collateral damage and improving ablation efficacy such as less musculature irritation and coughing compared to traditional methods.
Standard PFA uses microsecond pulses, while nsPFA uses pulses that are significantly shorter (typically 10 to 500 times shorter).
The nsPFA catheter used (Pulse Biosciences’s CellFX nsPFA Catheter), a nonirrigated, dual-purpose, circumferential catheter designed for both electroanatomic mapping and delivery of nsPFA.
The Pulse Biosciences system is integrated with CardioNXT’s iMAP 3-D mapping and navigation system, Abbott’s EnSite NavX electroanatomic mapping (EAM) system, and other EAM (Electroanatomic Mapping) navigation systems.
Standard PVI with Two Applications Per Vein
In this live ablation Dr. Neuzil did a simple PVI to isolate the PVs. He also used the catheter to map and render the LA-PV anatomy. The ten recording electrodes on the periphery of the two rings were used to position and localize the catheter. Dr. Neuzil started on the right side, then moved to the left.
Each vein received two monophasic PFA applications of 2.5 seconds, though 5-second-long applications can also be used. The first application seemed to be more interior to the vein with some folding of the catheter, while the second application was more exterior. (The sedation used completely paralyzed the patient.)
One of the purposes of using PFA pulses of such short duration was to avoid harming heart tissue and stimulating muscle.
The patient did have some coughing, though Dr. Neuzil thought there was less coughing than with other ablation strategies.
Non-PV Triggers Not Addressed in This Case
Dr. Neuzil explained that in this relatively simple case it was not necessary to search for non-PV triggers. [Many EPs today do a PVI first, then look for non-PV triggers.]
He did advise attendees that finding and ablating non-PV triggers today can account for as much as 50% of an EP’s work, whereas previously non-PVs were only 10% of an EP’s effort.
This patient’s ablation was finished later with the patient returning to normal sinus rhythm.
Editor’s Comments
Editor’s CommentsRadiofrequency and cryoablation technologies for PVI can both be time consuming and limited in efficacy.
Nanosecond PFA ablation seems like a very promising treatment for patients. It significantly increases the amplitude of the PFA pulse and lowers the duration of the pulse.
The PFA lesions made are better and deeper, while there is less chance of damage to surrounding heart tissue. But much more research needs to be done before it receives FDA approval.
