Multicenter Study Supports PFA for Atrial Fibrillation in HCM

Requiring only one procedure, pulsed field ablation (PFA) appears to be safe and effective for treating atrial fibrillation in patients with hypertrophic cardiomyopathy (HCM), including refractory cases. The technique is emerging as a novel, nonthermal energy source that may offer a safer alternative to traditional catheter ablation techniques.

Daniele Massera, MD, director of NYU Langone Health’s Hypertrophic Cardiomyopathy Program, is helping to pioneer PFA for patients with HCM, alongside Larry A. Chinitz, MD, director of the Heart Rhythm Center, and Mark V. Sherrid, MD, director of the hypertrophic cardiomyopathy research.

“There is limited data on PFA of atrial fibrillation in HCM,” Dr. Massera says. “At NYU Langone, PFA offers hope for patients who’ve been deemed unsuitable for ablation at other centers.”

NYU Langone is among the first to study the procedural characteristics, safety, and outcomes of PFA in a multicenter HCM atrial fibrillation cohort. Findings from their first series were presented at Heart Rhythm 2026.

Investigating PFA for Atrial Fibrillation in HCM

European regulators approved the first PFA device in January 2021, and the technology was later approved in the U.S. in 2024. PFA distinguishes itself from conventional thermal ablation by using short, high-energy electrical pulses to target and destroy problematic cardiac tissue, which significantly shortens procedure times and lowers risks to surrounding organs.

According to Dr. Chinitz, HCM patients are suitable candidates for PFA as they experience high rates of recurrent arrhythmias after single procedure radiofrequency ablation of atrial fibrillation.

“In HCM, atrial fibrillation tends to be more complex,” explains Dr. Chinitz. “PFA allows for more extensive ablation to be performed in a shorter timeframe with much better safety.”

Encouraging Early Outcomes

Among 133 patients included in the study, 51 percent had persistent atrial fibrillation and 32 percent had prior ablation. Overall, acute pulmonary vein isolation was achieved in 98 percent of the cohort.

The procedure was efficient, with a mean duration of 156.7 ± 75.8 minutes. After a median follow-up of 212 days, arrhythmia-free survival was 58.2 percent, and after applying a 60-day post-ablation blanking period—given that early post-procedural arrhythmias are often transient—arrhythmia-free survival rose to 66.7 percent.

Concerning safety, major complications were rare, including one cardiac tamponade event and no esophageal, phrenic, or major vascular injuries.

“PFA is feasible and can be quite successful in HCM patients,” says Dr. Sherrid. “There was also a very low rate of complications.”

Assessing Patient Candidacy

NYU Langone is uniquely equipped to comprehensively evaluate HCM patients with atrial fibrillation, for whom PFA might prove to be a viable treatment option, Dr. Massera explains.

“Our comprehensive evaluation includes risk stratification for sudden cardiac death, medical and surgical treatment of outflow obstruction, genetic evaluation, family screening, and more,” Dr. Massera says. “This technology has the potential to significantly transform catheter ablation procedures.”

If providers are unsure whether a patient may be a suitable candidate, referring them for consultation is highly recommended. “PFA is safe and can significantly impact patients’ quality of life,” Dr. Massera adds.