PFA Ablation, Antalya | Prof. Dr. Umuttan Doğan

Pulsed field ablation puts the heart tissue causing a rhythm disorder out of action with very short, high-voltage electrical pulses rather than by heating or freezing it. It is shortened to PFA. Its defining feature is tissue selectivity: the electrical field applied affects heart muscle cells at a lower threshold than the nerves and blood vessels around them. The method is used mostly in atrial fibrillation ablation.

Why Does the Kind of Energy Matter?

The aim of ablation is the same whatever the method: to take away the ability of the tissue that starts or sustains a rhythm disorder to conduct.

The difference lies in how that is done. The established methods use heat or cold. Both are thermal: they act on the tissue by changing its temperature.

Temperature is not selective. The oesophagus lies just behind the wall of the heart, the nerve that drives the diaphragm runs along one side, and the openings of the veins from the lungs are inside it. Heat or cold applied to the target tissue can reach those neighbours too.

PFA takes a different route at this point.

What Is Pulsed Field Ablation?

PFA stands for pulsed field ablation.

High-voltage electrical pulses, each lasting a tiny fraction of a second, are delivered from the tip of the catheter. They create a strong but very brief electrical field in the tissue. No heat is produced and the tissue is not frozen.

Electroporation: Pores in the Cell Membrane

The principle it works on is called electroporation.

Every cell is wrapped in a thin membrane. A strong electrical field opens very small pores in that membrane. If the field is strong enough the pores become permanent, the balance inside the cell is lost and the cell stops working.

In medical language this is irreversible electroporation. The tissue is neither burnt nor frozen; it is put out of action at the level of the cell.

Tissue Selectivity: What Sets PFA Apart

This section holds the most important information on the page.

Every type of tissue has its own threshold for electroporation. Heart muscle cells are affected by this field at a comparatively low threshold, while nerve tissue, the wall of a blood vessel and the oesophagus need a higher one.

When the field applied is held between those two thresholds, the aim is for the heart muscle to be affected while the neighbouring structures are largely spared.

Thermal methods make no such distinction; heat or cold affects every tissue it reaches. This is the aspect of PFA that is dwelt on.

It should be said that this is not a guarantee. Selectivity is a tendency, not absolute protection; the procedure still calls for careful planning and careful work.

What Is PFA Used For?

Its commonest use today is atrial fibrillation ablation.

The core of that procedure is creating an unbroken line around the openings where the veins from the lungs enter the left atrium; this is called pulmonary vein isolation. PFA can be used to create that line.

Its use is also spreading to additional lines within the atrium and to some other rhythm disorders.

How Is a PFA Procedure Carried Out?

It goes in through the vein in the groin. The catheters first reach the right atrium; to get to the left atrium, a controlled crossing is made through the thin wall that separates the two.

The catheter is placed at the target area and runs of pulses are delivered. Each run lasts seconds. At the end the isolation is measured to confirm that it is complete; this step is not skipped.

It can be used together with three-dimensional mapping where needed.

Why Is a General Anaesthetic Needed?

This is a detail patients should know in advance.

The pulses delivered stimulate not only the heart tissue but the muscles around it. Each run therefore brings a marked muscle contraction, and the procedure cannot be tolerated while awake.

PFA is for that reason generally done under a general anaesthetic or deep sedation. Muscle relaxants may also be used. The procedure is over when you wake, and you will not remember those contractions.

How Long Does It Take?

Because the energy is delivered quickly, the total time can be shorter in some patients than with the thermal methods. It would not be right to give a firm figure; the structure of the atrium, whether extra lines are needed and the patient’s condition all decide it.

What Is Measured During the Procedure?

Delivering the energy is only part of the work. What really counts is confirming that the line is genuinely complete.

Two checks are made, in both directions:

Has conduction inwards been cut? Impulses coming out of the pulmonary vein should no longer be able to reach the atrium.
Has conduction outwards been cut? An impulse delivered from inside the line should not be able to spread into the atrium either.

When both hold, the isolation is accepted as complete.

A waiting period then follows. Conduction that appears to be cut in the first minutes can return as the tissue recovers. The procedure is therefore not ended straight away; the measurement is repeated at the end of the wait and more energy is delivered if needed.

These confirming steps are not skipped in a pulsed field ablation either. Where a procedure is ended early, conduction is more likely to return.

How PFA, Radiofrequency and Cryoablation Differ

All three have the same goal. The difference is in the kind of energy and in how it acts on the tissue.

Radiofrequency: heat. The tissue is treated point by point and the line built one step at a time. Used flexibly together with three-dimensional mapping, which suits cases needing extra lines.
Cryoablation: cold. A balloon-shaped catheter seats at the mouth of the vein and freezing makes the ring in one go.
PFA: non-thermal energy. It works with short electrical pulses, and tissue selectivity is its defining feature.

Which is used is decided by weighing the structure of the atrium, how long the rhythm disorder has been going on, whether an ablation has been done before and the equipment available. More than one method can be used in the same session where needed.

Who Is Pulsed Field Ablation For?

Patients with atrial fibrillation whose palpitations and symptoms continue despite medication
Those who cannot take rhythm medicines because of side effects
People whose AF comes in episodes and for whom rhythm control is the goal
Anatomies where concern about the oesophagus or the phrenic nerve comes to the fore
Patients who have had an ablation before and in whom conduction has returned

When It May Not Be Suitable

Where there is a clot in the left atrium; the procedure is postponed
Where a general anaesthetic is unsuitable
Where there is a correctable cause behind the rhythm disorder; a thyroid disorder, for instance, is treated first
Where the atrium is very markedly enlarged
Where the target area does not suit the way a PFA catheter is applied

Whether it suits you is decided by weighing your test results and your rhythm recordings together.

Pulsed Field Ablation in Turkey

PFA has been in use worldwide since 2021. It began to be used in Turkey more recently and is currently carried out in a limited number of hospitals.

That the method is new means two things. On the one hand the device and the technique are developing quickly and experience grows year by year. On the other, data from very long follow-up is still accumulating; the method is therefore considered alongside the established options rather than in place of them.

How the procedure is covered may change over time. It is sensible to ask your doctor and your own insurer what applies in your case.

How Do You Prepare?

Checking for clot: shortly before the procedure, the left atrium is assessed with imaging for clot. If there is one, the procedure is postponed and blood-thinning treatment continued.
Anaesthetic assessment: because the procedure is done under a general anaesthetic or deep sedation, the anaesthetist sees you beforehand. You will be told then how long to fast.
Your list of medicines: bring everything you take, with the doses. You may be asked to stop some rhythm medicines beforehand; that decision is your doctor’s, so do not act on it yourself.
Blood thinners: your doctor decides how they are managed around the procedure. Do not stop them on your own.
Your rhythm recordings: bring any ECG and Holter recordings made during your palpitations; they have a direct bearing on the plan.
Someone with you: because an anaesthetic is given, you need somebody with you on the day and you must not drive.

At the consultation beforehand the expected benefit, the possible risks and the alternative methods are explained, and your written consent is taken.

What Are the Possible Risks?

Bruising, bleeding or injury to the vessel at the access site
A small opening left in the wall that was crossed; it usually closes by itself
Fluid collecting in the sac around the heart; rare, and drained if needed
Events caused by clot around the time of the procedure; this is why blood thinners are managed so carefully
Temporary discomfort from the muscle contractions; this is why an anaesthetic is given
The rhythm disorder returning in time, with a second procedure needed

The risks are weighed against the benefit expected from the procedure and discussed in detail for your own situation at the consultation beforehand.

Afterwards

Pressure is applied at the access site in the groin and bed rest is advised for a period.
Because an anaesthetic was given, you are asked not to drive that day and to have somebody with you.
The first three months are the blanking period; episodes of palpitations during it are to be expected and do not mean the procedure has failed.
Blood-thinning treatment is followed for the period your doctor sets. Do not stop it on your own.
Weight, sleep apnoea, alcohol and blood pressure all affect the result of an ablation directly.
Cardiology review is carried out at set intervals, with rhythm recordings if needed.

Pulsed Field Ablation in Antalya

Prof. Dr. Umuttan Doğan is a cardiologist who trained in electrophysiology at the Gülhane Military Medical Academy in 2012; ablation of rhythm disorders using radiofrequency, cryoballoon and PFA energy is one of the areas he works in. The procedures are carried out in the catheter laboratory at Antalya American Hospital.

If you have palpitations, or ablation has been suggested to you, you can be seen at the clinic in Konyaaltı with your ECG and Holter recordings. For the other methods see the rhythm disorders and ablation page. You will find his background and contact details on their own pages.

Frequently Asked Questions

What is the difference between PFA and radiofrequency ablation?

Radiofrequency uses heat and puts the tissue out of action by warming it. PFA produces no heat; it opens permanent pores in the cell membrane with very short electrical pulses. What is dwelt on with PFA is that it affects heart muscle cells at a lower threshold than the surrounding tissues.

Will I be awake during the procedure?

Usually not. Because the pulses also stimulate the muscles around the heart, each run brings a marked muscle contraction, and that cannot be tolerated while awake. The procedure is therefore done under a general anaesthetic or deep sedation, and you will not remember the contractions.

Can PFA be used for every rhythm disorder?

No. Its common use today is pulmonary vein isolation in atrial fibrillation. In some rhythm disorders the shape or position of the target area may not suit the way a PFA catheter is applied; radiofrequency or cryoablation is preferred in those cases.

PFA is a new method — is it reliable?

It has been in use worldwide since 2021 and experience grows year by year. Tissue selectivity is the feature dwelt on most. That said, data from very long follow-up is still accumulating, and like every interventional procedure PFA has risks of its own. The method is therefore considered alongside the established options rather than in place of them.

What happens if my palpitations carry on after PFA?

The first three months are called the blanking period, and episodes during it are to be expected; while the treated tissue heals it stays excitable for a while longer. No judgement is made before the three months are up. It helps to record the episodes you have in that time and show them to your doctor at your review.

The information on this page is for general guidance and does not replace a consultation. Decisions about diagnosis and treatment are made by your doctor after assessing your own situation.