Pulsed Field Ablation Versus Thermal Energy Ablation for Atrial Fibrillation

Pulsed field ablation, in commercially available formulations, is as effective as thermal ablation in controlling atrial fibrillation. In contrast to thermal ablation, pulsed field ablation has preferential tissue selectivity and reduces risk of injury to adjacent non-myocardial structures (eg, esophagus, phrenic nerve), and its mechanism of myocyte injury reduces risk of pulmonary vein stenosis. Pulsed field ablation may reduce overall procedure time, although often at the cost of increased fluoroscopy use, compared to thermal ablation. Pulsed field ablation incurs risks of coronary vasospasm and acute kidney injury from hemolysis, which must be considered and proactively managed.