Sydney hospital marks cardiac milestone as PFA competition heats up

Nepean Private Hospital, operated by Healthscope, has reached a clinical milestone with the introduction of Boston Scientific’s OPAL HDx Mapping System, an advanced technology designed to create detailed, real-time 3D maps of electrical activity inside a patient’s heart.

The new system is being used to support electrophysiologists in diagnosing and treating complex cardiac rhythm disorders, including atrial fibrillation (AF). Developed by Boston Scientific, the OPAL HDx Mapping System is a sophisticated 3D cardiac mapping and navigation platform that supports both radiofrequency (RF) ablation and pulsed field ablation (PFA) procedures.

Dr Ihab El-Sokkari performed the hospital’s first procedure using the new 3D heart-mapping technology. The introduction was followed the next day by a second case led by Dr Juliana Kanawati, marking the early clinical use of the technology.

The deployment comes as competition intensifies among cardiac electrophysiology technology providers, particularly in the rapidly developing PFA market.

Johnson & Johnson MedTech’s CARTO cardiac mapping system is a competitor to OPAL HDx. The company entered the PFA market after Boston Scientific and Medtronic and suffered an early setback when safety concerns triggered a pause in U.S. use of the original Varipulse system.

Now Johnson & Johnson has initiated the PERSIGMA head-to-head clinical randomised controlled trial (RCT), comparing its next-generation PFA platform with Boston Scientific’s rival system.

The study will compare J&J’s Varipulse Pro platform and Boston Scientific’s Farapulse PFA system in people with persistent atrial fibrillation. Its primary endpoints include safety, assessed through the occurrence of primary adverse events, and effectiveness, defined by freedom from arrhythmia recurrence during the 60-day evaluation period following the procedure.

The company said it is taking a “deliberate step forward to generate clear, comparative evidence and bring greater rigor to how PFA technologies are evaluated”.

The growing focus on cardiac mapping and ablation technologies comes against the backdrop of a persistent burden of atrial fibrillation. It is the most common cardiac arrhythmia and remains a significant public health challenge, affecting more than 500,000 Australians and accounting for roughly 219,000 hospitalisations each year.

However, Australia’s capacity to measure and benchmark AF care remains constrained by gaps in data infrastructure. A recent study identified a lack of a population-level registry, limiting the ability to track longitudinal outcomes, monitor treatment patterns and benchmark performance.

Digital capability and interoperability also remain fragmented across care settings, particularly outside tertiary centres, highlighting the broader challenge of ensuring that advances in cardiac technology are supported by consistent data, connectivity and clinical infrastructure.

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