Pulsed-field ablation: recent advancement in catheter ablation of atrial fibrillation

INTRODUCTION: Ablation for rhythm control of atrial fibrillation originated in the 1990s and has been dominated by thermal ablation techniques such as radiofrequency ablation and cryoballoon ablation. However, more recently, pulsed field ablation has offered a cutting-edge nonthermal technique that minimizes the complications previously seen in thermal ablation. AREAS COVERED: We present a review of the existing literature regarding pulsed field ablation for atrial fibrillation. We provide an overview of the history of ablation techniques, the mechanism of pulse field ablation, and procedural characteristics of pulse field ablation. We also present both short-term and long-term outcomes of the procedure in addition to an overview of possible complications. EXPERT OPINION: It is the authors' opinion that pulsed field ablation represents an exciting ablation technique for the treatment of atrial fibrillation that has a minimal learning curve for those already experienced in thermal ablation techniques. It also demonstrates noninferior, and in some cases superior, outcomes in comparison to thermal ablation and has fewer complications. Further studies are needed to evaluate long-term outcomes and complications past one-year post ablation.