Catheter ablation using pulsed-field energy: Do we finally have the magic wand to defeat atrial fibrillation?

Abstract

Clinical outcomes of catheter ablation remain suboptimal in patients with atrial fibrillation (AF), particularly in those with persistent AF, despite decades of research, clinical trials, and technological advancements. Recently, pulsed-field ablation (PFA), a promising non-thermal technology, has been introduced to improve procedural outcomes. Its unique feature of myocardial selectivity offers safety advantages by avoiding potential harm to vulnerable adjacent structures during AF ablation. However, despite the global enthusiasm within the electrophysiology community, recent data indicate that PFA is still far from being a “magic wand” for addressing such a complex and challenging arrhythmia as AF. More progress is needed in mapping processes rather than in ablation technology. This editorial reviews relevant available data and explores future research directions for PFA.

Keywords: Atrial fibrillation; Pulsed field ablation; Radiofrequency ablation; Electroporation; Electroanatomic mapping; Catheter ablation; Interventional cardiology; Cardiac arrhythmias

Core Tip: Pulse-field ablation is an emerging technology in the field of arrhythmia ablation based on electroporation method, particularly adopted for atrial fibrillation. While there is growing interest in the safety and efficacy of catheter ablation using electroporation, several aspects of its long-term effectiveness and procedural limitations require further investigation before pulse-field ablation can be considered a definitive solution for atrial fibrillation.