Evaluating catheter usage for atrial fibrillation ablation: improving rates of efficacy and safety

Pulmonary vein (PV) isolation remains the cornerstone of atrial fibrillation (AF) catheter ablation. While the single-tip radiofrequency-based PV isolation in conjunction with a 3D mapping system was for many years considered to be the 'gold standard,' the strategy of PV isolation has evolved tremendously in the recent years.

This review explores the latest energy source and catheter technologies developed in order to improve the efficiency, safety, and persistence of acute success over the long-term follow-up in patients undergoing PV isolation for AF ablation. Relevant articles were searched in PubMed, Scopus, and Cochrane databases up to August 2025.

Radiofrequency remains a milestone, especially in the field of the point-by-point ablation manner. The introduction of the temperature-controlled ablation catheters allows ablation with higher power settings compared to standard power-controlled ablation, resulting in high acute and one-year success rate with a low incidence of complications. Similar results have been reported with both cryoballoon ablation system, with shorter procedural time and longer fluoroscopy time. Pulsed field ablation is a novel ablation modality, largely nonthermal, aiming at creating transmural, durable ablation lesions while reducing the risk of collateral damage.