The FDA has approved Johnson & Johnson MedTech's VARIPULSE pulsed field ablation (PFA) platform for treating drug-refractory paroxysmal atrial fibrillation (AF). This approval marks a significant advancement in AF treatment, offering a single device that combines PFA therapy and advanced mapping capabilities. The VARIPULSE platform is designed for integration with the CARTO 3D electroanatomical cardiac mapping system, enhancing the accuracy and safety of ablation procedures.
VARIPULSE Platform Details
The VARIPULSE platform allows electrophysiologists to deliver precise energy while visualizing catheter positioning in real-time. Its integration with intracardiac echocardiography (ICE) enables minimal- to zero-fluoro workflow, enhancing safety during procedures. The platform provides critical feedback on lesion durability, potentially improving long-term outcomes for patients undergoing AF ablation.
Clinical Trial Data
The FDA's approval was based on 12-month outcome data from the pivotal phase of the admIRE trial, a prospective, multi-center, non-randomized study. The trial involved 291 patients across 30 US healthcare centers. Results showed that 100% of patients achieved acute procedural success, with 98% demonstrating first-pass isolation per vein. Peak primary effectiveness was achieved in nearly 85% of patients, with 73–96 applications per vein. The study also reported a low adverse event rate of 2.9%. Notably, approximately 25% of procedures were performed without fluoroscopy, attributed to the platform's integration with the CARTO 3 System.
Expert Commentary
According to Andrea Natale, MD, executive medical director, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, innovative solutions like VARIPULSE are critical for expanding options for patients with AF. He noted the platform's efficient procedures and favorable safety profile, allowing for the treatment of more patients. Luigi Di Biase, MD, PhD, System Director of Electrophysiology at Montefiore Health System, emphasized the importance of mapping integration for electrophysiologists to visualize the heart and deliver pulsed field energy accurately, potentially reducing procedure time and improving patient outcomes.
Market and Disease Context
Atrial fibrillation affects over 8 million people in the US and 50 million worldwide, with approximately 1 in 4 adults over 40 at risk of developing the condition. Catheter ablation is a safe and effective method for restoring the heart’s electrical signals when drug therapies fail. The VARIPULSE platform offers a comprehensive solution for both routine and complex AF ablations, addressing a significant unmet need in the treatment of this widespread condition.
