The Role of PFA in Atrial Fibrillation Ablation: Case Report and Review of Literature

Abstract: Atrial fibrillation (AF) is the most common clinically significant arrhythmia, often originating from ectopic foci in the pulmonary veins (PV). Pulmonary vein isolation (PVI) remains the cornerstone of AF management. Pulsed field ablation (PFA), a non-thermal technique utilizing irreversible electroporation, offers selective myocardial ablation while sparing surrounding tissues, presenting a safer alternative to thermal methods. We report a 65-year-old man with paroxysmal AF, triple-vessel coronary artery disease, hypertension, and cardiac remodeling, who presented with worsening chest discomfort and fatigue. Preprocedural imaging via multi-slice CT and transesophageal echocardiography confirmed suitable anatomy. Under general anesthesia, PVI using the FARAPULSE PFA system was performed, achieving successful bidirectional isolation of all four PVs without complications. The patient maintained sinus rhythm and was discharged hemodynamically stable. This case highlights PFA's feasibility and safety, even in high-risk patients, supporting its growing role in AF ablation strategies. Key Message: Pulsed field ablation (PFA) offers a safe and effective alternative to thermal ablation in atrial fibrillation management. Its tissue-selective mechanism allows precise pulmonary vein isolation with minimal complications, even in high-risk patients with complex cardiac comorbidities. Preprocedural imaging remains essential for procedural success.