Ablation procedures often improve atrial fibrillation (AFib) symptoms but have traditionally followed medication-based treatment due to the risk of rare but serious — sometimes deadly — complications.
Edmond Obeng-Gyimah, MD,
That is starting to change because pulsed field ablation (PFA) has upended the risk-benefit calculation. Since PFA became available last year, an ever-growing number of physicians are considering it a first-line treatment for their patients with AFib.
In the Q&A below, Edmond Obeng-Gyimah, MD, a cardiac electrophysiologist who was one of the first physicians in Pennsylvania to offer PFA, discusses how this innovative technology has transformed the AFib treatment landscape.
What makes pulsed field ablation safer for AFib patients?
Millions of PFA procedures have been performed around the world by now, and we're seeing significantly fewer complications compared with older ablation technologies, like radiofrequency ablation.
Although radiofrequency ablation is effective, it carries a 1 in 3,000 risk of creating a fistula in the esophagus, which is fatal in 80%-90% of cases. It can also damage the phrenic nerve, leading to breathing difficulties that typically last several months.
PFA can sidestep these serious complications because it delivers quick bursts of electrical pulses that selectively block the abnormal signals in the heart that cause AFib. In contrast, radiofrequency delivers heat energy that can harm nearby healthy tissue in the esophagus and the phrenic nerve.
Like all ablation procedures, PFA carries a small risk of bleeding, blood clots and stroke — but these risks are actually less than other risks with long-term medication use.
What kind of outcomes are you seeing with PFA?
We're seeing that PFA could be more effective than other ablation technologies. Our team started using PFA in April 2024, just a few months after the first device was approved by the U.S. Food and Drug Administration, and we've now performed more than 1,000 procedures.
We don’t have formal outcomes data for PFA yet, but anecdotally, we’ve seen that about 85%-90% of our patients have a successful response to PFA in the last year. That’s compared with 70%-75% of patients who have been reported nationwide to respond to radiofrequency ablation. Success means no longer needing to take medication or being able to manage AFib with medication, compared to before ablation.
What can patients expect after PFA?
Most patients are recovering faster from PFA than from other ablation procedures, probably because it is a shorter procedure and they don’t spend as much time under anesthesia. They also aren’t feeling chest pain after PFA, which they often feel after radiofrequency ablation because the heat energy causes inflammation around the heart.
Who’s a good candidate for PFA?
Most patients who have AFib and are eligible to undergo an ablation procedure are good candidates for PFA. That includes patients with earlier stages of AFib who may have previously managed their condition with medications, like amiodarone. In fact, these patients often make ideal candidates for PFA because their condition is more likely to be curable.
Also consider:
- Patients whose AFib didn’t respond to medications.
- Elderly patients, even those in their late 80s. We regularly perform PFA for elderly patients with excellent outcomes.
How can I recognize more early-stage AFib?
Many patients with AFib don’t experience fluttering or pounding in the chest. Instead, they have more general symptoms like fatigue or brain fog. Sometimes irregular heart rhythms can be picked up using a stethoscope or by feeling the pulse, but not always.
That’s why we recommend that individuals get annual EKGs if they are 65 and older and have diabetes or high blood pressure — all factors that increase the risk of AFib.
What can patients expect after I refer them to WellSpan Health?
Our cardiac electrophysiology team will do the full diagnostic workup and discuss all possible treatment options with AFib patients, keeping you informed along the way. If PFA is right for them, we schedule the procedure and then see patients at six weeks, six months and one year after that. We continue following them as long as needed, and if they have other heart issues, we coordinate with our general cardiology team to ensure they get the care they need.
Above all, you can trust that your patients will receive personalized care from experts who are national leaders in electrophysiology, practicing at one of the highest-volume ablation centers in the U.S.