Guttipatti Pavithran, Saadallah Najla, Wan Elaine Y
Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Heart Surg Forum. 2024;27(2):E169-E179. doi: 10.59958/hsf.7141. Epub 2024 Feb 22.
Pulsed field ablation (PFA) is a novel technology to treat atrial fibrillation (AF) utilizing electric fields to induce nonthermal irreversible electroporation of electrically active cardiac tissue to induce cardiac cell death. PFA offers improved safety benefits compared to traditional radiofrequency ablation (RFA) and cryoablation by specifically ablating only cardiac tissue. However, there are avenues for further optimization including neurological risk associated with microbubble formation and left atrial function post ablation. Various PFA devices with different electric pulse waveforms have been studied and tested in human trials, with the majority utilizing microsecond duration pulses. Shorter nanosecond duration pulses, or nanosecond PFA, is beginning to be studied for AF ablation. In this review we will delve into current waveforms used for PFA, areas for improvement, mechanisms behind nanosecond PFA, and its clinical impact for cardiac ablation.
脉冲场消融（PFA）是一种治疗心房颤动（AF）的新技术，它利用电场诱导电活动心肌组织发生非热不可逆电穿孔，从而导致心肌细胞死亡。与传统的射频消融（RFA）和冷冻消融相比，PFA通过仅特异性消融心肌组织而具有更好的安全性。然而，仍有进一步优化的途径，包括与微泡形成相关的神经学风险以及消融后的左心房功能。各种具有不同电脉冲波形的PFA设备已在人体试验中进行了研究和测试，大多数使用微秒级持续时间的脉冲。更短的纳秒级持续时间脉冲，即纳秒PFA，已开始用于房颤消融的研究。在本综述中，我们将深入探讨用于PFA的当前波形、改进领域、纳秒PFA背后的机制及其对心脏消融的临床影响。
