Considerations regarding safety with pulsed field ablation for atrial fibrillation

The introduction of pulsed field ablation (PFA) in electrophysiology marks a significant advancement, promising efficacy comparable to thermal ablation methods while potentially providing safety advantages. Despite a generally favorable safety profile in human trials and postmarket registries, cautious evaluation of PFA's safety is essential. This review provides a comprehensive overview of key safety considerations as we discuss a myriad of considerations ranging from thermal effects, gaseous microbubble formation, muscle contractions, and proarrhythmia to procedural techniques. We explore specific safety concerns with phrenic nerve injury, cerebral lesions, coronary artery spasm, hemolysis and pulmonary bleeding. Vigilance in safety monitoring, coupled with advancements in procedural techniques and understanding of PFA's unique effects, is crucial for optimizing the safe and effective use of PFA.