ReviewEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Pulsed field ablation: from concepts to technology.
Review in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
aimsPulsed field ablation (PFA) has emerged as a transformative approach for treating cardiac arrhythmias by exploiting irreversible electroporation to preferentially injure myocardium while limiting collateral damage. Translating this biophysical principle into safe and effective clinical systems requires careful integration of waveform design, catheter engineering, computational and experimental modelling, safety testing, and procedural workflow.
objectiveThis review summarizes the fundamental physical and engineering principles that govern cardiac PFA and examines how these principles influence efficacy, safety, lesion formation, and clinical usability. BIOPHYSICAL AND TECHNICAL CONSIDERATIONS: Electroporation is governed primarily by the local electric field and waveform-dependent lethal thresholds rather than generator voltage alone. Key waveform variables include monophasic vs. biphasic pulses, microsecond vs. nanosecond pulse widths, duty cycle, and total application duration. Catheter design further determines electric field distribution, lesion geometry, current density, and applicability across anatomic targets, with important distinctions between bipolar and monopolar configurations. MODELLING AND SAFETY: Experimental and computational approaches used to investigate PFA include finite element simulations, cell culture systems, vegetal substrates, and in vivo animal models, each with distinct strengths and limitations. High-voltage pulse delivery can also produce unintended effects, including Joule heating, electrochemical reactions, bubble formation, arcing, and interactions with implanted electronic devices. These phenomena highlight the importance of optimized waveform design, electrode configuration, and safety monitoring. CLINICAL USABILITY: Clinical adoption depends not only on biological efficacy and safety but also on workflow efficiency, catheter versatility, procedure duration, mapping integration, anaesthesia requirements, and adaptability to differing clinical practices and geographic settings.
conclusionsThe performance of a PFA system reflects the interaction of biophysics, waveform characteristics, catheter design, modelling, safety controls, and procedural usability. Understanding these interconnected principles is essential for developing PFA technologies that are effective, safe, predictable, and practical for contemporary electrophysiology laboratories.
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