Received 11 March 2024; accepted after revision 7 May 2024; online publish-ahead-of-print 7 June 2024 | Kyoung-Ryul Julian Chun, Damijan Miklavčič, Konstantinos Vlachos, Stefano Bordignon, Daniel Scherr, Pierre Jais, and Boris Schmidt
Pulsed field ablation (PFA) is an innovative technique in cardiac electrophysiology that uses pulsed electric fields to induce irreversible electroporation, leading to targeted tissue destruction. Unlike traditional catheter ablation methods that use radiofrequency or cryothermal energy, PFA offers several advantages, including reduced risk of thermal collateral damage and predictable procedural outcomes. This review summarizes the biophysical principles and clinical applications of PFA, highlighting its potential benefits over conventional ablation methods. Contemporary PFA devices combine short, high-energy electrical pulses with predictable procedural outcomes and reduced thermal collateral damage. The rapid evolution of PFA catheters has been driven by technological advancements, with future developments potentially impacting patient care. The review discusses the mechanisms of electroporation, the role of contact force, and the integration of PFA with 3D mapping systems. It also covers the performance, safety, and efficacy of PFA in treating atrial fibrillation (AF) and ventricular tachycardia (VT), emphasizing the potential for PFA to address complex arrhythmias and improve patient outcomes. Despite its promising features, more research and clinical experience are needed to fully establish the role of PFA in cardiac electrophysiology.Pulsed field ablation (PFA) is an innovative technique in cardiac electrophysiology that uses pulsed electric fields to induce irreversible electroporation, leading to targeted tissue destruction. Unlike traditional catheter ablation methods that use radiofrequency or cryothermal energy, PFA offers several advantages, including reduced risk of thermal collateral damage and predictable procedural outcomes. This review summarizes the biophysical principles and clinical applications of PFA, highlighting its potential benefits over conventional ablation methods. Contemporary PFA devices combine short, high-energy electrical pulses with predictable procedural outcomes and reduced thermal collateral damage. The rapid evolution of PFA catheters has been driven by technological advancements, with future developments potentially impacting patient care. The review discusses the mechanisms of electroporation, the role of contact force, and the integration of PFA with 3D mapping systems. It also covers the performance, safety, and efficacy of PFA in treating atrial fibrillation (AF) and ventricular tachycardia (VT), emphasizing the potential for PFA to address complex arrhythmias and improve patient outcomes. Despite its promising features, more research and clinical experience are needed to fully establish the role of PFA in cardiac electrophysiology.