Pulsed field ablation: Disrupting technology in cardiac electrophysiology

Pulsed field ablation (PFA) is being adopted as a safer and more efficient alternative to conventional thermal ablation methods for the treatment of cardiac arrhythmias, particularly atrial fibrillation. In this review, we examine the basic biophysics of PFA, focusing on electroporation at the membrane, cellular, and tissue levels to provide mechanistic explanations for the observed clinical outcomes. We analyze both the benefits and limitations of the nonthermal, tissue-selective nature of PFA, examine adverse events, and emphasize the need for standardized comparisons among different manufacturers' systems. Drawing on decades of electroporation research in other biomedical fields, we suggest that deeper scientific understanding is key to optimizing PFA technology, improving long-term outcomes, and maintaining its strong safety profile. Open questions and future directions for clinical translation and refinement of the procedure are also discussed, considering both atrial and ventricular ablation.