| Keywords [eng] |
Atrial fibrillation, pulsed field ablation, safety ; efficacy, complications, catheters, tissue selectivity, electroporation, PVI |
| Abstract [eng] |
Background: Pulsed Field Ablation (PFA) is the latest commercially available energy modality for arrhythmia treatment. Initially used in cancer therapy, PFA has now emerged as a promising approach for atrial fibrillation (AF) ablation. Alongside radiofrequency (RF) and cryoablation, PFA is widely used in clinical practice. Comparative studies with small patient cohorts, such as the ADVENT trial have employed a noninferiority design, showing no statistically significant differences between these ablation modalities. Methods: A systematic review of recent studies, including randomized clinical trials, meta-analyses, and registry-based investigations, was conducted. Key findings from studies such as PULSED AF, MANIFEST-17K and ECLIPSE AF were analyzed to determine acute and long-term success rates, procedural efficiency, and complication rates. Results: Findings indicate that PFA achieves high acute success rates (95–98%) with durable pulmonary vein isolation in 85–95% of cases after one year. Registry data suggest that PFA may offer superior safety compared to RF and cryoablation, as it has not been associated with energy-specific complications such as phrenic nerve palsy, pulmonary vein stenosis, or atrioesophageal fistula. Additionally, procedural efficiency is improved, as PFA enables faster ablations with potentially lower procedural risks. Clinical experience also suggests that post-procedural symptoms, such as chest discomfort, are less frequent following PFA compared to RF or cryoablation. Conclusion: PFA represents a safe and efficient alternative to traditional ablation techniques for AF treatment. Tissue selectivity is among its key advantages. The reviewed studies highlight its superior safety profile, procedural efficiency, and long-term effectiveness. However, data on repeat ablations remain inconclusive, and further large-scale comparative trials are necessary to assess the long-term advantages of PFA over conventional energy sources. |
