Updates in Pulsed Field Ablation for the Treatment of Atrial Fibrillation, Including Safety, Efficacy, and Future Directions

Interview With Amin Al-Ahmad, MD

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In this interview from Western AF 2024, we speak with Amin Al-Ahmad, MD, from Texas Cardiac Arrhythmia in Austin, Texas, about updates in pulsed field ablation (PFA) for the treatment of atrial fibrillation (AF). 

What has been your personal exposure to PFA during its development in the United States and elsewhere?

We have been fortunate to be part of the different PFA studies at TCA in Austin, so we have been able to participate in different technologies and enroll patients in the clinical studies. With commercial approval, we have been able to start doing procedures commercially in our lab in Austin.

What are the main pros and cons to PFA compared to thermal devices for AF ablation?

I think the major pro with PFA is the safety profile. In particular, because it is nonthermal, we do not have to worry a lot about collateral damage, meaning things like the phrenic nerve, esophagus, issues with the bronchus, all sorts of things that we worry about as electrophysiologists, we do not have to worry about as much with PFA. I think that strong safety signal is important for us as a field in order to help patients with their AF. We want this to be as safe a procedure as possible. For a condition that does not generally kill you, it should be a safe procedure.

Will PFA be widely adopted in cardiac electrophysiology labs in the United States, and how will it roll out as more options become commercially available?

I do believe that PFA will be widely adopted. In fact, my prediction is that PFA over time will start to become the dominant technology for at least de novo AF ablation. We will have to see as the technology develops whether redo ablations end up being part PFA, part radiofrequency. But at least for de novo AF ablation, my belief is that it will be predominantly PFA. How it rolls out in the United States is different. There are a lot of different factors that play into that, and cost is one of them. But in general, my suspicion is it will start to roll out, and over the next few years, we will start to see that transformation. 

As centers adopt PFA, do you think this will have a major impact on patient selection, anesthesia use, procedural volume, etc?

That is a great question. I think that it probably will, and there is probably going to be some things that happen that I do not quite anticipate now, as we are only beginning the journey with PFA. But I do think that there is going to be potential for it to impact us in ways like that. For example, there are certainly patients where we worry about stiff left atrial syndrome that we do not tend to see with PFA; because of the safety signal with PFA, it may allow us to treat patients that we would not otherwise. So, I do think that we will see that, but how that happens over time, I am not able to predict just yet. However, I do think we will see some change in patient selection and workflow and that kind of environment for us.

What is your favorite part about the Western AF Symposium?

The Western AF Symposium is a great symposium. I think the nice thing about it is the symposium really asks the questions that we all want to hear answered. All the tough questions about anticoagulation and how we grapple with these things as clinicians, the conference really strives to answer. It is not just about the technology, it is about the patient in general. I think it is a very patient-centered conference for us as clinicians, which I really like. It is one of my favorite conferences. 

The transcripts have been edited for clarity and length.