Microbubble Formation and Hemolysis in Pulsed Field Ablation for Treating Arrhythmia: Risks, Mechanisms, and...

Pulsed Field Ablation (PFA) is an emerging energy modality for cardiac ablation, offering shorter atrial dwell times and reduced collateral damage compared to thermal methods. However, energy-related complications, specifically gaseous microbubble formation and hemolysis, require further evaluation. Microbubble formation, driven by electrolysis, boiling, and degassing, poses a potential risk for embolic events. Similarly, hemolysis results from unintended energy dissipation into the bloodstream, affecting kidney function. Both complications can be mitigated through optimized waveform and catheter design and other procedural strategies. Enhancing PFA safety requires a deeper understanding of its biophysical interactions and continuous refinement of ablation protocols to minimize risks while preserving clinical efficacy.