Safer and faster treatment for atrial fibrillation
Atrial fibrillation(opens in new window) is the most common heart rhythm disorder worldwide and a major cause of illness and premature death. Affecting around one in 10 people over the age of 65, the condition disrupts the heart’s normal electrical activity, increasing the risk of stroke, heart failure, mortality and dementia. Catheter ablation(opens in new window) has become an established treatment, relying primarily on radiofrequency or cryothermal energy to create lesions that block abnormal electrical signals originating in the pulmonary veins. While effective, these approaches work by burning cardiac tissue, heating or freezing tissue and may inadvertently damage nearby structures.
Moving beyond thermal ablation
The EU-funded BEAT AF(opens in new window) project brought together nine leading clinical centres across Europe to investigate whether pulsed electric field ablation could offer a safer and more effective alternative to conventional thermal ablation techniques. The goal was to test pulsed-field ablation, a fundamentally different strategy that uses high-intensity electrical pulses to disrupt the cell membrane without significant heat generation. The rationale behind this approach is based on the fact that cardiac cells are particularly sensitive to pulsed electric fields, while surrounding tissues such as the oesophagus and phrenic nerve are far less affected. “Pulsed-field ablation demonstrates a high degree of tissue selectivity which translates into a markedly improved safety profile,” explains project coordinator Pierre Jaïs. The technology works by creating nanoscale pores in cell membranes through a process known as electroporation. By avoiding thermal injury, it reduces the risk of complications associated with conventional ablation, including pulmonary vein narrowing and damage to neighbouring structures.
Therapy testing in clinical trials
The BEAT AF consortium launched two randomised clinical trials(opens in new window) designed to evaluate the potential of pulsed-field ablation in atrial fibrillation. The studies sought to determine whether the technology could improve efficacy while maintaining a superior safety profile. The results(opens in new window) demonstrated that pulsed-field ablation achieved efficacy comparable to radiofrequency ablation after one year of follow-up. Although superiority in arrhythmia recurrence was not demonstrated, the findings were highly encouraging given the relative maturity of the competing technologies. According to Jaïs: “Pulsed-field ablation represents a first-generation commercial technology, whereas radiofrequency ablation has benefited from more than 30 years of continuous refinement. Achieving comparable efficacy at this stage is therefore a very encouraging result.” The most striking outcomes relate to safety. Pulmonary vein stenosis, a known complication of thermal ablation, was not observed with pulsed-field ablation in the clinical studies. The technology also showed substantial potential to reduce other complications linked to thermal tissue injury.
Improving access to treatment
Beyond safety improvements, BEAT AF demonstrated that pulsed-field ablation can simplify procedures and reduce treatment times. This could have important implications for healthcare systems facing growing numbers of patients with atrial fibrillation. “Pulsed-field ablation has the potential to transform atrial fibrillation management, as its procedural efficiency could potentially allow nearly twice as many patients to be treated within the same laboratory time,” highlights Jaïs. This could help broaden access to catheter ablation, which currently reaches only a small proportion of eligible patients. Earlier intervention may become possible for patient groups that have traditionally been considered more challenging to treat, including older and frail individuals experiencing severe symptoms or recurrent hospitalisations.
