Radiofrequency Ablation for Atrial Fibrillation in the Pulsed Field Era　― Mechanisms, Principles, and Future Roles ―

Catheter ablation has become the cornerstone therapy for cardiac arrhythmias, supported by continuous technological innovation. Since the introduction of radiofrequency (RF) ablation in the 1980s, remarkable progress, such as open irrigation, contact force sensing, local impedance monitoring, and index-guided ablation, has significantly improved procedural safety, reproducibility, and efficacy. In atrial fibrillation ablation, pulmonary vein isolation remains the fundamental strategy, and advances in RF technology have contributed to durable lesion formation and reduced complications. Although new non-thermal energy sources such as pulsed-field ablation (PFA) have recently emerged, RF ablation continues to play a central role in clinical practice. Its ability to provide precise lesion control and adaptability across a wide range of arrhythmia substrates, including supraventricular and ventricular tachycardias, remains unmatched. Furthermore, recent developments such as dual-energy catheters capable of delivering both RFA and PFA suggest a complementary future for both modalities. RF ablation has evolved in pursuit of greater safety and efficiency through sustained technological advancement. These innovations have improved lesion predictability and procedural outcomes, and RF ablation will remain an indispensable component of arrhythmia management in the coming era of energy diversification.