Next Big Things: Why Pulsed Field Ablation Will Revolutionize the Treatment of AF

Catheter ablation of cardiac arrhythmias represents one of the best end markets in MedTech, with worldwide sales growing at an 11% CAGR over the past decade to top $7.2B in 2022. While our clinical understanding of atrial fibrillation and the tools available to electrophysiologists to address it have both improved markedly over the past two decades, catheter ablation remains an imperfect procedure today, associated with mediocre long-term efficacy and rare but potentially serious complications. Pulsed field ablation (PFA) has the potential to revolutionize the treatment of AF by eliminating many of these shortcomings.

While we’re bullish on PFA as a technology, all PFA systems aren’t created equal. The pulsed field waveform is significantly more complex than the energy modalities that preceded it, with numerous variables determining the “dose” being delivered to the myocardium and the quality of the resulting lesion. And while a wide variety of PFA systems have demonstrated the ability to achieve acute electrical isolation, sub-threshold dosing or gaps in the lesion set can result in eroding durability over time. Certain catheter designs may also be more prone to complications, something we expect both clinicians and patients to have a low tolerance for. Finally, we see ease-of-use as a key consideration, with PFA offering the potential to democratize AF ablation by enabling lower volume centers and less skilled operators to achieve high-quality results.

To help Nephron clients get their arms around this emerging space and think through the implications of a revolution that could upend a >$7B market, yesterday we published out PFA primer. In this deep dive report, we discuss the science behind PFA, the device-specific attributes of each of the programs in late-stage development, and the potential advantages and disadvantages of each approach. We also walk through the financial impact widespread PFA adoption could have on the major players in the EP ablation market over the next few years.

For more information on Chris’ report and Nephron Research, please email: