Pulsed Field Ablation for Atrial Fibrillation: Contemporary Clinical Evidence and Real-World Experience in Redo Ablation

Figure 1. Technological workflow evolution and key clinical outcomes of PFA for atrial fibrillation. The upper panel illustrates the transition from a sequential workflow, electroanatomic mapping followed by pulsed field ablation using separate catheters, to integrated systems enabling combined high-density mapping and ablation with a single catheter. The lower panel summarizes key findings from major clinical studies, including acute pulmonary vein isolation rates, lesion durability on remapping, imaging-based tissue effects, 12-month arrhythmia outcomes, and safety endpoints. Figure created in BioRender. Bozika, M. (2025) https://BioRender.com/6xb5zp7 (accessed on 2 December 2025).

Figure 2. Bipolar (left) atrial mapping with Intellamap Orion catheter and Opal HDX system demonstrates reconnection in all 4 pulmonary veins and scar in the posterior wall adjacent to right inferior pulmonary vein. On the (right) panel LA voltage map post PVI and posterior wall isolation with Farawave PFA catheter.

Figure 3. Bipolar LA mapping with Intellamap Orion catheter and Opal HDX system shows ostially isolated (left/right)-sided pulmonary veins pre-redo PFA. Right panel demonstrates successful wide area circumferential isolation of all PVs (gray area) while the posterior wall is healthy (purple color).

Figure 4. (Left) side panel depicts reconnected left-sided veins based on voltage LA mapping with Orion Intellamap catheter. (Right) side panel demonstrates low voltage areas in all four pulmonary veins following successful pulmonary vein isolation with the Farawave pulsed field ablation catheter.

Figure 5. (A). Atypical atrial flutter with proximal to distal Cs activation. Earliest activation in RUPV. (B). Voltage mapping with Orion Intellamap catheter demonstrates reconnected RUPV and (C,D). Earliest activation and signal in RUPV and successful termination of atrial flutter with Farawave PFA applications. PFA lesions were represented by the colored rings.

Figure 6. (A).Voltage LA mapping with Affera mapping system demonstrates reconnected RIPV with purple voltage. (B). Application of PFA lesions (green dots) and isolation of RIPV and posterior wall. (C). Previous cavotricuspid isthmus line was connected. Further RF lesions (red dots) were applied, and LAT mapping represents line of block across the isthmus.