What is Pulsed Field Ablation?

Pulsed Field Ablation is one of the minimally invasive procedures that uses catheter ablation to aid atrial fibrillation. PFA uses high voltage electrical energy to ablate the targeted heart membrane.¹ 

Electroporation plays an important role during PFA procedure. Electroporation is the process of creating small pores in the cell membrane using electrical energy. This mechanism is utilized in Pulsed Field Ablation to “damage” target cells without excessive heat. Similar to the traditional heart ablation (radiofrequency/cryoablation) procedure, PFA can be the solution of heart arrhythmias. So, what is the difference between traditional heart ablation and PFA?

The Difference Between Traditional Ablation Procedure and PFA

ablasi konvensional dan pfa

Traditional heart ablation methods use radiofrequency and cryoablation. Both of the procedures use thermal energy (heat on radiofrequency and cold on cryoablation) to “destroy” a heart membrane, while PFA uses electrical energy. 

The usage of thermal energy to aid atrial fibrillation has been proven to be effective, but can create damages on the surrounding tissue, mainly on esophagus (throat), nervous system, and blood vessels.

On the other hand, the high voltage electrical energy on PFA is more selective, meaning the energy will only ablate the targeted membrane. That being said, PFA procedure is a safer option with less side effects, compared to the traditional ablation methods.

Category

Pulsed Field Ablation

Traditional Ablation

Mechanism

Electroporation 

Thermal energy (heat and cold)

Procedure Duration

1–3 hours

3–5 hours

Additional Risks:

Low: The risk of injury to the esophagus, phrenic nerve, and pulmonary veins is significantly reduced.

Higher: Thermal energy (heat/cold) may sometimes cause injury to the esophagus, phrenic nerve, and pulmonary veins.

Effectivity

Newer procedure: Clinically proven to effectively treat atrial fibrillation with an improved safety profile.

Established procedure: comparable effectiveness to PFA

Who Can Perform PFA Procedure?

Specialists who are eligible to perform PFA are cardiologists with a subspecialist in electrophysiology. The operating room will also be occupied with a medical team consisting of nurses, technicians, anesthesia doctors, and cardiac imagery specialists.

PFA Could Be An Option For

Ablation is one of the pillars in the management of atrial fibrillation. However, it cannot be denied that the risk of recurrence after atrial fibrillation ablation remains relatively high (15–20%). Earlier ablation treatment can reduce the risk of recurrence. Therefore, because PFA offers better safety and a shorter procedure time than conventional atrial fibrillation ablation, it is often chosen as a preferred treatment option.¹

Patients with these conditions can consider undergoing PFA:

  1. Have persistent atrial fibrillation, especially if it causes symptoms.

  2. Are unable or unwilling to take atrial fibrillation medications.

If you have experienced any of the symptoms listed above, PFA may be an effective treatment option for you.

What Should Be Prepared Before PFA?

The doctor will review the medications you are currently taking and recommend any necessary adjustments prior to the procedure. You will also need to undergo a series of tests so the doctor can assess your heart condition. The required tests include:

  1. Echocardiogram

  2. Cardiac CT scan

  3. Blood tests

How Is the PFA Procedure Performed?

prosedur pfa

PFA is categorized as a minimally invasive procedure. During this procedure, the doctor accesses the patient’s heart through the groin area and uses various types of catheters.

What happens during a PFA procedure:¹

  1. In the groin area, the doctor makes a small puncture using a needle and inserts a catheter through a blood vessel.

  2. The catheter is then guided toward the heart.

  3. The catheter is positioned inside the heart, near the target area. For the treatment of atrial fibrillation, the catheter is placed close to the pulmonary veins.

  4. High-voltage electrical energy is delivered through electrodes at the tip of the catheter. At this stage, the doctor may reposition the catheter repeatedly to cover the entire target area.

  5. After confirming the absence of atrial fibrillation rhythm following ablation, the catheter is removed, and the incision is closed.

Recovery Period After PFA 

In general, patients can go home one day after the PFA procedure. The results of the procedure will be re-evaluated three months afterward. By this time, post-procedure recovery should be complete, and abnormal heart rhythms (atrial fibrillation) should no longer be present.

Altius Hospitals Successfully Performed the First Pulsed Field Ablation!

pfa altius

A team of cardiology specialists consisting of dr. Elisa Feriyanti Pakpahan, Sp.JP, FIHA, FAsCC; dr. Firman Tedjasukmana, Sp.JP; and led by dr. Antono Sutandar, Sp.JP(K), FIHA, FACC, successfully performed the first PFA procedure at Altius Hospitals Harapan Indah. The two-hour procedure marks a significant milestone in Altius Hospitals’ clinical journey.

References

  1. Cleveland Clinic. (2020). Pulsed-Field Ablation: A New, Highly Selective Catheter Ablation Method for Heart Arrhythmias. Cleveland Clinic. https://consultqd.clevelandclinic.org/pulsed-field-ablation-a-new-highly-selective-catheter-ablation-method-for-heart-arrhythmias

  2. John Hopkins Medicine. (2025, December 9). Pulsed Field Ablation. Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pulsed-field-ablation

  3. Mayo Clinic. (2024, February 2). Cardiac ablation - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/tests-procedures/cardiac-ablation/about/pac-20384993