Pulsed Field Ablation for Atrial Fibrillation in Japan: Current Status and Future Perspectives

Catheter ablation of atrial fibrillation (AF) is an established therapeutic strategy, with pulmonary vein isolation as the cornerstone of ablative therapy. Although radiofrequency and cryothermal energies have been the main energy sources, the past decade has witnessed remarkable scientific progress and growing interest in pulsed field ablation (PFA) as a novel energy modality, leading to the recent clinical adoption of PFA technologies for AF treatment. In Japan, PFA was introduced into clinical practice in 2024 and has been rapidly accepted. Unlike traditional thermal energies, PFA uses pulsed electric fields to induce irreversible electroporation, selectively targeting myocardial tissue while preserving adjacent structures from thermal or mechanical injury. Offering procedural efficacy comparable to conventional thermal ablation, PFA distinguishes itself by enabling shorter procedure times and reducing the risk of complications. This review summarizes the mechanisms of PFA, currently available systems in Japan, reported clinical outcomes and complications, as well as limitations and future perspectives.