Why the study?
Thermal catheter ablation for atrial fibrillation is effective but remains associated with severe complications like pulmonary vein stenosis and atrioesophageal fistula, prompting review of pulsed field ablation as a non-thermal alternative.
Does pulsed field ablation improve safety and maintain efficacy compared to thermal ablation in patients with atrial fibrillation?
Does pulsed field ablation improve safety and maintain efficacy compared to thermal ablation in patients with atrial fibrillation?
Pulsed field ablation is a promising non-thermal alternative to thermal ablation for atrial fibrillation, potentially reducing severe complications while maintaining efficacy.
PFA may reduce collateral damage in AF ablation; leaves open need for RCTs to confirm safety and efficacy.
INTRODUCTION: Catheter ablation has traditionally been performed using thermal modalities, which, despite being effective, remain associated with potentially severe complications such as pulmonary vein stenosis and atrioesophageal fistula. Pulsed field ablation (PFA), a non-thermal technique based on irreversible electroporation, has emerged as a promising alternative, with the potential to maintain the efficacy of thermal energies while minimizing collateral damage to surrounding structures. AREAS COVERED: This review discusses the safety and efficacy of PFA for atrial fibrillation (AF) ablation. We analyzed the latest clinical evidence on PFA lesion durability and effectiveness, integrating insights from our clinical experience and workflow. The safety profile of PFA is critically examined, highlighting its advantages in reducing complications while addressing emerging PFA-specific adverse effects such as hemolysis and coronary vasospasm. EXPERT OPINION: PFA promises to overcome the safety limitations encountered during AF ablation with thermal modalities. This may permit earlier referrals, treatment of more complex patients, and adoption of a more individualized, extensive ablation approach. Despite this, PFA still requires technological and workflow optimization due to challenges in lesion durability, real-time lesion assessment, and emerging concerns about energy-specific side effects. These issues require operator awareness and are expected to be addressed with second-generation PFA systems.
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Zito et al. (2025) studied this question.
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