Pulse Field Ablation: An Update on Energy-Specific Adverse Events

Pulsed field ablation (PFA) represents a paradigm shift in cardiac ablation technology. Indeed, PFA, a non-thermal technique, achieves homogeneous tissue effects by delivering ultrashort, high-frequency electric pulses. Moreover, PFA has emerged as a prominent ablation strategy in electrophysiology laboratories worldwide. While current clinical evidence demonstrated promising outcomes and expanded applications for existing PFA platforms, energy-specific difficulties complicated the definition of safety boundaries, particularly in patients with clinical complications. Furthermore, substantial heterogeneity among commercial PFA systems impeded procedural standardization. Therefore, this review aimed to synthesize contemporary perspectives on mitigating these energy-specific adverse events, with emphasis on modifiable perioperative factors. The evidence of safety across commercially available PFA systems with divergent catheter design philosophies was concurrently evaluated to examine how design strategies influence procedural safety profiles.