IMR Press / RCM / Volume 25 / Issue 4 / DOI: 10.31083/j.rcm2504138
Open Access Review
Pulsed Field Ablation for Atrial Fibrillation: Mechanisms, Advantages, and Limitations
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1 Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
2 Xiangya School of Medicine, Central South University, 410013 Changsha, Hunan, China
3 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
*Correspondence: yichaoxiao@csu.edu.cn (Yichao Xiao)
Rev. Cardiovasc. Med. 2024, 25(4), 138; https://doi.org/10.31083/j.rcm2504138
Submitted: 11 October 2023 | Revised: 14 November 2023 | Accepted: 28 November 2023 | Published: 8 April 2024
(This article belongs to the Section Cardiovascular Intervention and Therapeutics)
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Pulsed field ablation with irreversible electroporation for the treatment of atrial fibrillation involves tissue-specific and non-thermal energy-induced cell necrosis, which helps avoid complications, such as pulmonary vein stenosis, atrial collateral tissue damage, and extensive atrial structural damage, often encountered with traditional thermal ablation. In existing clinical trials, pulsed field ablation has shown excellent effects on pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. Pulsed field ablation is easy, simple, and quick and can reduce iatrogenic injury. Therefore, the application of pulsed field ablation technology in the treatment of atrial fibrillation has a promising future. Notably, the adjustment of parameters in pulsed field ablation with different ablation catheter systems can strongly affect the area and depth of the necrotic myocardium, which greatly affects the likelihood of atrial fibrillation recurrence and incidence of adverse complications after ablation. In this paper, we review the mechanisms, advantages, and limitations of pulsed field ablation based on the results of a series of previous studies and provide ideas and directions for future research.

Keywords
pulsed electric field
atrial fibrillation
catheter ablation
pulmonary vein isolation
irreversible electroporation
Funding
2021SK53519/Clinical Medical Technology Innovation Guidance Project of Hunan Science and Technology Agency
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