February 2025

CARDIOVASCULAR

MEDTRONIC PULSED-FIELD ABLATION PROCEDURE USING THE AFFERA SYSTEM

Featuring: Bradley P. Knight, MD
On January 28, Bradley P. Knight, MD, director of Cardiac Electrophysiology at Northwestern Medicine, performed a Medtronic pulsed-field ablation procedure using the new Affera mapping system. The mapping system and Sphere-9 catheter just received FDA approval in October 2024. The new system expands Northwestern Medicine Bluhm Cardiovascular Institute's pulsed field ablation offerings, underscoring the institute's commitment to improving outcomes through leading-edge technology.
​​Northwestern Medicine is among the first in the nation to use this innovative technology. The health system was also first in Illinois and among the first in the nation to perform pulsed field ablation for patients with atrial fibrillation (AFib) last year.
Advances in Ablation
“In general, pulse field ablation, or PFA, is a major advance in the field of catheter ablation for patients with heart rhythm problems,” says Dr. Knight. “Nothing in our field in the last 25 years has been so disruptive.”
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The Medtronic Sphere 9 PFA catheter integrated with the Affera mapping system is another major advance in the field. The new PFA systems deliver very brief high-voltage electrical pulses to electrodes on a catheter that are placed in contact with cardiac tissue. Unlike radiofrequency (RF) energy, this doesn’t create significant heat; and it doesn’t create cold as with cryo-energy. This allows for efficient ablation of cardiac tissue without injuring surrounding structures.
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Key Benefits
  • The Sphere 9 catheter is a smaller focal ablation catheter with a soft cage-like tip that can be used to create customized linear lesions in the atrium using a point-by-point approach.
  • The tip is much larger than the standard RF ablation catheter. Its diameter is 9 millimeters rather than 4 millimeters, allowing it to be used much like the previous RF catheter but it creates much larger ablation lesions.
  • The tip is highly flexible, reducing the risk of cardiac perforation and improving catheter stability.
  • The physician can deliver RF energy in certain locations in the heart, such as near a coronary artery, rather than PFA energy.
  • Unlike other PFA ablation catheters, it can be used to perform ultra-high density electroanatomic mapping to generate voltage and activation maps with the nine microelectrodes on the spherical cage integrated in the new Affera mapping system.
The Impact of Innovation
Northwestern Medicine has been early adopter of PFA for cardiac ablation, focusing its use in patients with refractory AFib. The team has had experience with the Medtronic PulseSelect PFA system since January 2024 and the Boston Scientific FaraPulse system since July 2024.
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In part due to the adoption of PFA, Northwestern Medicine has been able to provide care for more patients with AFib. In 2024, AFib ablation volume increased by 27% at Northwestern Medicine compared to the previous year and 55% compared to 2022.
“We are thrilled to be the first EP program in Illinois to have access to it for our patients,” says Dr. Knight, highlighting that the Sphere 9 PFA catheter represents a revolutionary addition to the cardiac electrophysiologist's toolbox.
Bradley P. Knight, MD, Director of Cardiac Electrophysiology and the Chester C. and Deborah M. Cooley Distinguished Professor of Cardiology at Northwestern Medicine Professor​

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