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Correspondence to Author: Tyleder Chinedu Chinyereier, Ikeotunur Royal Chinyereier. 

College of Medicine—Phoenix, University of Arizona, Phoenix, AZ 85004, USA

Abstract: Adverse left atrial (LA) remodeling, dilatation, and scar tissue formation facilitate atrial fibrillation (AF), a common comorbidity in heart failure (HF) with preserved ejection fraction (HFpEF). Poor compliance of the left ventricle facilitates these alterations. Treating concurrent HF requires treating atrial tachyrhythms with catheter ablation (CA), according to an increasing quantity of clinical data and medical guidelines. This advice is challenging because thermal CA techniques, such as cryoablation and radiofrequency ablation, both work by creating more scar tissue. For patients who already have significant scarring from HFpEF, AF therapy with thermal CA may increase the burden of atrial scarring.Thus, thermal CA may serve as the "gasoline" for the LA's slowly smoldering "fire," speeding up the recurrence of AF. Using high-voltage irreversible electroporation, pulsed-field ablation (PFA) is a non-thermal CA approach that can break up arrhythmogenic foci and reentrant microcircuits without leaving a large scar. By acting as "water" instead of "gasoline," PFA may lessen the severe fibrosis response to thermal CA that predisposes to AF.PFA may therefore improve the longevity and effectiveness of CA for AF in HFpEF, which may in turn reduce the likelihood of procedural issues from successive CAs.The clinical principles underlying HFpEF and AF are briefly discussed in this article, followed by an overview of the available evidence regarding PFA's potential as a better CA method for AF in the context of coexisting HFpEF.

Citation:

Ikeotunur Royal Chinyereier. Pulsed-Field Ablation For The Treatment Of Left Atrial Tachyrhythms In The Context Of Hfpef: Putting Water On Fire?. Journal of Advanced Therapeutics 2025.