When the ablation electrodes are placed in contact with cardiac tissue, short pulses of high voltage electricity in the range of hundreds to low thousands of volts are delivered through the electrodes. These pulses create small pores or holes in the cell membranes of the targeted cardiac cells through electroporation. The electroporated cells undergo apoptosis or programmed cell death without causing thermal damage to surrounding tissues. This non-thermal mechanism of ablation allows for more precise tissue disruption without collateral damage. The pulses can be precisely delivered to reshape cardiac conduction pathways and electrically isolate arrhythmogenic substrates.

Advantages over Conventional Ablation Techniques

PFA offers several potential advantages over conventional RFA for cardiac ablation procedures:

• Precision and control: PFA allows for targeted disruption of only the cardiomyocytes within the electric field generated by the ablation electrodes. This provides better precision and control over the ablation process compared to thermal technologies which rely on heat diffusion.

• Minimized collateral damage: Without generating heat, PFA can ablate target cardiac tissue with minimal damage to surrounding muscle and blood vessels. This helps reduce complications such as steam pops, thrombus formation, and cardiac wall necrosis seen with RFA.

• Faster procedure time: As PFA is a non-thermal technology, it does not require waiting for tissue cooling between successive ablation points. This helps reduce overall procedure time.

• Improved lesion formation: The non-thermal mechanism allows for more homogeneous lesion formation compared to heat-based techniques which are affected by blood flow cooling effects.

• Better assessment of lesion formation: Lesion formation through PFA can be monitored electrically during the procedure through impedance or conduction block confirmation. This enables better assessment compared to RFA where assessment relies on waiting for tissue cooling.

Pulsed Field Ablation -  https://www.coherentmi.com/blog/pulsed-field-ablation-a-promising-emerging-technology-for-cardiac-ablation-procedures-141