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FARAPULSE™

Pulsed Field Ablation System

Transforming tissue-selective ablation

FARAPULSE Pulsed Field Ablation video.
 
Radiofrequency ablation and cryo ablation, with potential complications of PV stenosis, phrenic nerve palsy, and AE fistula.
Pulsed field ablation: other tissues/cell types are more resistant to PFA, remained uninjured despite exposure to the field.
The goal of Pulsed Field Ablation (PFA) therapy is to isolate and target specific characteristics of cardiac tissue for irreversible electroporation (IRE) to induce cell death and durable lesions using a non-thermal energy source. Unlike thermal methods, PFA is cardiac tissue-selective due to the lower damage threshold for cardiomyocytes. This addresses the risk of collateral injury to adjacent structures.
 

PFA therapy is restricted to only the intended target1

Cardiomyocytes are ablated; nerve cell, esophageal smooth muscle, and vascular smooth muscle are preserved.
Cardiomyocytes have low thresholds to PFA while other tissue/cell types are more resistant and remained uninjured despite exposure to the field.
 

Irreversible electroporation2

Precise electric field targets myocardial cells; cell membranes form nanoscale pores; cell contents exit through pores.


The mechanism of action for pulsed field ablation is irreversible electroporation. Unlike thermal ablation that causes cell death by local tissue temperature, pulsed field ablation applies ultra-rapid electrical pulses above a tissue cell’s specific electrical threshold, destabilizing the cell membrane and forming nanoscale pores that cause the cell’s contents to exit resulting in the cell death.

Reversible electroporation can occur if pores are not large enough to cause permanent cell death, which could show immediate loss of intracardiac electrograms. This could be perceived as acute isolation through cardiac stunning without achieving the irreversible electroporation needed for durable lesions.

 
Learn more at Farapulse university.
  
 
FARAPULSE Pulsed Field Ablation System Indications, Safety and Warnings

References:

1. Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019 Jul 23;74(3):315-26.
2. Kotnik T, Kramar P, Pucihar G, et al. Cell membrane electroporation-Part 1: The phenomenon. IEEE Electrical Insulation. 2012;28(5):14-23.

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