Treatment of paroxysmal and persistent atrial fibrillation with pulsed field ablation

Pulsed field ablation has emerged as a novel energy source for atrial fibrillation ablation, offering preferential myocardial ablation with a favourable safety profile. Contemporary paroxysmal AF clinical studies demonstrate 12-month freedom from atrial arrhythmia recurrence in approximately 75-85% of patients, with major complication rates generally ranging from 1 to 3%. Compared with thermal ablation, PFA offers comparable efficacy and streamlined procedural workflows. In persistent AF, PVI remains the foundation of ablation, while additional adjunctive strategies are increasingly evaluated. Current evidence suggests that PFA can achieve 12-month arrhythmia-free outcomes generally ranging from approximately 60-75% in persistent AF populations. Major procedure-related complications typically occur in <3% of cases, supporting the feasibility of broader lesion sets with an acceptable safety profile. However, the incremental benefit of adjunctive ablation beyond PVI and the optimal lesion set for persistent AF remain to be assessed further Outcome assessment after PFA requires consideration of evolving endpoints. The clinical relevance of the traditional post-ablation blanking period is being re-evaluated, while continuous rhythm monitoring and AF burden are increasingly incorporated alongside conventional recurrence endpoints. Patient-reported outcomes are an important component of PFA evaluation. Compared with thermal ablation, PFA is associated with improved procedural tolerability, reduced analgesic requirements, rapid recovery, and the potential for same-day discharge. These features, together with favourable efficacy and safety outcomes, may contribute to broader adoption of PFA across both paroxysmal and persistent AF populations.