Calicut, June 8: In a landmark achievement for cardiac electrophysiology in Kerala, Metromed International Cardiac Centre, Calicut, has successfully performed the state's first Pulsed Field Ablation (PFA) procedure for the treatment of atrial fibrillation (AF), marking a significant milestone in the evolution of advanced heart rhythm management. The procedures were carried out on June 5, 2026, as part of a series of cases on day one of the national launch of PFA technology in India.
Three patients suffering from paroxysmal atrial fibrillation underwent the novel procedure at Metromed International Cardiac Centre using the FARAPULSE™️ system from Boston Scientific. The interventions were performed by the hospital's electrophysiology team led by Dr Arun Gopi, Head of the Electrophysiology Division, Department of Cardiology, without the assistance of an external proctor.
The successful completion of these cases places Metromed among the pioneering institutions in the country to adopt this breakthrough technology on the very first day of its availability in India. More importantly, these procedures represent the first-ever PFA cases performed in Kerala, further strengthening the state's position in delivering cutting-edge cardiac care.
Highlighting the significance of the achievement, Dr Mohammed Musthafa, Chairman of Metromed International Cardiac Centre and Head of Cardiology, stated:
"The successful completion of Kerala's first Pulsed Field Ablation procedures marks a proud moment not only for our institution but also for the entire cardiac care community in the state. These cases were performed on the very first day of PFA's launch in India and form part of the initial series of procedures undertaken nationally. Being among the earliest centres in the country to adopt this transformative technology reflects our commitment to bringing world-class innovations to patients without delay. Metromed has consistently invested in advanced electrophysiology infrastructure, training and expertise. Our goal remains to provide patients access to the safest and most effective therapies available anywhere in the world."
Understanding Atrial Fibrillation: A Common Yet Serious Heart Rhythm Disorder
Atrial fibrillation, commonly known as AF, is the most prevalent sustained cardiac arrhythmia worldwide. In this condition, the upper chambers of the heart, known as the atria, beat rapidly and irregularly instead of contracting in a coordinated manner. Patients often experience symptoms such as palpitations, breathlessness, fatigue, reduced exercise tolerance, dizziness, or chest discomfort. However, some individuals may remain asymptomatic, making the condition difficult to detect.
AF is not merely a disturbance of heart rhythm; it carries significant health risks. The irregular beating of the atria can lead to blood stagnation and clot formation within the heart. These clots may travel to the brain and cause stroke. Patients with atrial fibrillation have a substantially higher risk of stroke compared to the general population. In addition, AF can contribute to heart failure, deterioration in cardiac function, repeated hospitalizations, and reduced quality of life. Early diagnosis and appropriate treatment are therefore crucial in preventing long-term complications.
Discussing the procedural aspects, Dr Arun Gopi, Head of the Electrophysiology Division, elaborated:
"The procedures were performed using a contemporary Pulsed Field Ablation platform designed specifically for pulmonary vein isolation in patients with paroxysmal atrial fibrillation. The interventions were carried out under comprehensive intracardiac echocardiographic guidance, enabling real-time visualization of cardiac structures throughout the procedure."
"Following vascular access through the femoral veins, intracardiac echocardiography (ICE) was utilized to guide transseptal puncture, allowing safe access from the right atrium into the left atrium. Detailed anatomical assessment of the left atrium and pulmonary veins was performed, after which the PFA catheter was positioned sequentially at each pulmonary vein ostium. Pulsed electrical fields were delivered in a controlled manner to achieve circumferential pulmonary vein isolation."
"The selective nature of pulsed field energy allows effective myocardial ablation while preserving adjacent structures. All three patients underwent successful pulmonary vein isolation with excellent procedural outcomes."
Speaking about the advancement represented by PFA technology, Dr Swasthi S Kumar, Consultant Cardiologist and member of the Electrophysiology Team, explained:
"The treatment of atrial fibrillation has evolved remarkably over the past two decades. Initially, pulmonary vein isolation was performed using radiofrequency ablation, where thermal energy is delivered point-by-point to create lesions around the pulmonary veins. While highly effective, radiofrequency ablation carries a risk of collateral injury to surrounding structures such as the oesophagus, phrenic nerve and pulmonary veins. Cryoballoon ablation later simplified the procedure by using freezing energy to isolate the pulmonary veins in a more uniform manner. Although cryoablation shortened procedural times and improved reproducibility, it still relies on thermal injury and shares some limitations associated with heat-based technologies."
"Pulsed Field Ablation represents a major paradigm shift. Instead of heat or freezing, it uses precisely delivered high-voltage electrical pulses to create irreversible electroporation of cardiac cells. This energy is highly selective for myocardial tissue, allowing effective ablation while minimizing injury to neighbouring structures. The result is a safer and more efficient procedure with shorter energy delivery times and an improved safety profile. PFA has rapidly gained acceptance internationally and is increasingly being considered the future of atrial fibrillation ablation."
Metromed International Cardiac Centre has established itself as one of the country's leading centres for comprehensive cardiac care, with a special emphasis on advanced electrophysiology interventions. The introduction of Pulsed Field Ablation further expands the centre's capabilities in managing complex heart rhythm disorders and offers patients access to one of the most significant technological advances in modern arrhythmia treatment.
With the successful completion of Kerala's first PFA procedures, Metromed has once again demonstrated its commitment to innovation, clinical excellence and the adoption of cutting-edge technologies that improve patient outcomes and redefine standards of care.
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