Current Safety Profile of Pulse Field Ablation: Not Everything that Shines Is Gold

Pulse field ablation is a novel, non-thermal alternative for catheter ablation of atrial fibrillation. Preclinical and early clinical studies have demonstrated a favorable safety profile with significant reductions in esophageal and pulmonary vein injury compared to radiofrequency ablation. However, there are still procedural and energy-related complications inherent to electroporation, tissue selectivity, and energy-dosing. Minimizing the frequency of application and extent of energy, as well as careful selection of the energy source, may mitigate these adverse events. There remains controversy and a lack of long-term outcomes, highlighting the need for further evaluation.