Pulsed Field Ablation from Bench to Bedside: A Physician’s Perspective

Pulsed field ablation (PFA) is an evolving technique in clinical practice for catheter ablation of AF. Because of its non-thermal mechanism (electroporation), it offers significant tissue-sparing advantages. Several preclinical reports have confirmed its safety and efficacy in both atrial and ventricular ablation. Subsequently, a large body of encouraging data has emerged, including randomised clinical trials and real-world registries evaluating several different PFA catheters for left atrial ablation. While preclinical work has detailed the biophysical features and lesion characteristics of PFA, subsequent clinical data have expanded knowledge of the efficacy and safety of various PFA systems. After the success of PFA for atrial arrhythmias, investigations are assessing its utility to treat ventricular arrhythmias. This article briefly reviews biophysical parameters and lesion science and summarises the outcomes of recent clinical studies.