Does pulsed field ablation provide selective cardiac injury and lower complication rates compared to radiofrequency and cryoballoon ablation in atrial fibrillation?
Pulsed field ablation offers selective myocardial injury with lower complication rates than traditional thermal ablation modalities, though further research is needed to optimize safety.
PURPOSE OF REVIEW: This review examines the selective cardiac injury induced by pulsed electric fields during atrial fibrillation ablation. It consolidates findings from both preclinical and clinical studies on cardiac selectivity and explores the potential mechanisms behind this selectivity. RECENT FINDINGS: Preclinical studies indicate that pulsed electric fields cause significantly more myocardial injury compared with other tissues. Clinical studies have similarly shown that complication rates for pulsed field ablation are notably lower than those for radiofrequency and cryoballoon ablation. SUMMARY: Pulsed field ablation demonstrates a notable selectivity for myocardial injury, likely because of the unique functional and metabolic characteristics of cardiomyocytes. This review delves into the underlying principles of cardiac selectivity and proposes future directions for improving this selectivity. It is important to note that while pulsed field ablation shows promise, its cardiac selectivity is not absolute, as some complications still occur, necessitating further research.
Meng et al. (Wed,) studied this question.