IMR Press / RCM / Volume 24 / Issue 11 / DOI: 10.31083/j.rcm2411337
Open Access Review
Pulsed Field Ablation of Atrial Fibrillation: A Comprehensive Review
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1 Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
2 Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin 050021, Colombia
3 HCA Electrophysiology, Mercy Hospital, Miami, FL 33133, USA
*Correspondence: (Jorge E. Romero); (Jose Osorio)
These authors contributed equally.
These authors contributed equally as co-senior authors.
Rev. Cardiovasc. Med. 2023, 24(11), 337;
Submitted: 3 August 2023 | Revised: 26 August 2023 | Accepted: 31 August 2023 | Published: 30 November 2023
(This article belongs to the Special Issue Advances in Catheter Ablation of Atrial Fibrillation)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Pulsed-field ablation (PFA) has emerged as a promising nonthermal ablation alternative for treating atrial fibrillation (AF). By delivering ultra-rapid high-energy electrical pulses, PFA induces irreversible electroporation, selectively targeting myocardial tissue while sparing adjacent structures from thermal or other damage. This article provides a comprehensive review of multiple pre-clinical studies, clinical studies, and clinical trials evaluating the safety, efficacy, and long-term outcomes of PFA in various settings and patient populations. Overall, the reviewed evidence highlights PFA’s potential as a revolutionary ablation strategy for AF treatment. Offering comparable procedural efficacy to conventional ablation methods, PFA distinguishes itself with shorter procedure times and reduced risks of complications such as phrenic nerve palsy and potential esophageal injury. While further research is warranted to establish long-term efficacy, PFA’s distinct advantages and evolving clinical evidence suggest a promising future for this novel nonthermal ablation approach. As PFA continues to advance, it has the potential to transform AF ablation procedures, providing a safer alternative for patients with atrial fibrillation.

atrial fibrillation
catheter ablation
pulsed-field ablation
Fig. 1.
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