Progress in pulsed field ablation for atrial fibrillation and perioperative nursing strategies

Abstract

Atrial fibrillation (AF) is a prevalent and progressive arrhythmia, presenting significant challenges in management due to its complex pathophysiology and multi-organ implications. Traditional treatment methods, such as pharmacological interventions and thermal catheter ablation, have limitations, including adverse effects and suboptimal long-term outcomes. Pulsed field ablation (PFA) emerges as a novel non-thermal technique for AF management, offering advantages in tissue selectivity and safety. This review evaluates the mechanisms, clinical efficacy, and perioperative care strategies for PFA, with a focus on its safety profile, procedural efficiency, and comparative benefits over traditional thermal ablation techniques. Key findings indicate that PFA demonstrates comparable or superior acute success rates for pulmonary vein isolation and a significantly lower risk of complications, such as esophageal and phrenic nerve injuries, compared to traditional methods. Furthermore, PFA reduces procedural time and offers greater tissue selectivity, minimizing collateral damage. Despite promising short-term results, long-term efficacy and optimal energy parameters for persistent AF remain to be thoroughly investigated in larger, multi-center trials. The unique contribution of this manuscript lies in providing a comprehensive synthesis of the current evidence surrounding PFA, outlining its potential to revolutionize AF ablation strategies by offering a safer, more efficient, and precise alternative to traditional thermal methods.

Keywords: Pulsed field ablation; Atrial fibrillation; Catheter ablation; Non-thermal ablation techniques; Perioperative care

Core Tip: Pulsed field ablation (PFA) emphasizes the safety benefits, particularly its reduced risk of complications like esophageal and phrenic nerve damage, compared to traditional thermal ablation methods. PFA demonstrates comparable or superior outcomes in terms of acute success rates for pulmonary vein isolation and procedural efficiency. Address the importance of long-term studies to confirm the durability of PFA lesions, as most current evidence focuses on short- and mid-term results. Note that PFA significantly reduces procedural time and tissue damage, which could lower the risks associated with prolonged surgeries. Stress the importance of comprehensive perioperative care, including preoperative risk assessment, intraoperative monitoring, and postoperative rehabilitation, to maximize PFA’s benefits.