Pulsed Field Ablation Advantages — EECC MCQ

Correct answer: D — PFA uses high-voltage ultrashort electrical pulses that preferentially ablate cardiomyocytes while sparing adjacent structures (oesophagus, phrenic nerve, coronary arteries) — this tissue selectivity reduces collateral damage compared with thermal-based RF and cryoablation

Pulsed field ablation (PFA) is a non-thermal ablation technology using high-voltage, ultrashort (microsecond-nanosecond) electrical pulses to cause irreversible electroporation — creating permanent pores in cell membranes leading to cell death. The key innovation: tissue selectivity — cardiomyocytes are preferentially susceptible to PFA at lower energy thresholds than surrounding tissues (oesophageal smooth muscle, phrenic nerve, coronary endothelium). This translates to: (1) near-zero oesophageal injury (the most feared RF ablation complication — atrio-oesophageal fistula); (2) minimal phrenic nerve injury (<1% vs ~5% with cryoablation); (3) no coronary artery thermal injury. The ADVENT trial (2023 — first RCT of PFA vs RF/cryo) showed non-inferior efficacy with a superior safety profile. The 2024 ESC AF Guidelines include PFA alongside RF and cryoablation as an ablation energy source for PVI.

Reference: ESC (2024): AF Guidelines; ADVENT Trial