{
  "abstract": "Aims\n\nPulsed 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.Objective\n\nThis 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\n\nElectroporation 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\n\nExperimental 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\n\nClinical 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.Conclusions\n\nThe 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiovascular Disease, University Clinical Hospital, Split, Croatia.",
    "Department of Engineering, Universitat Pompeu Fabra, Barcelona, Spain.",
    "Department of Electrophysiology, Boston Scientific Corporation, 4100 Hamline Ave. N, St. Paul, MN 55112, USA.",
    "Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ante Anić",
      "orcid": "0000-0002-6864-3999"
    },
    {
      "affs": [
        1
      ],
      "name": "Antoni Ivorra",
      "orcid": "0000-0001-7718-8767"
    },
    {
      "affs": [
        2
      ],
      "name": "Brendan Koop",
      "orcid": "0009-0006-5786-627X"
    },
    {
      "affs": [
        2
      ],
      "name": "Nathan J Kirkpatrick",
      "orcid": "0000-0002-6263-7387"
    },
    {
      "affs": [
        3
      ],
      "name": "Jacob Koruth",
      "orcid": "0000-0002-2221-8372"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7q90bsrx6qrk6.bib",
  "cited_by": 0,
  "doi": "10.1093/europace/euag205",
  "fulltext_url": "https://europepmc.org/articles/PMC13685804",
  "id": "7q90bsrx6qrk6",
  "issns": [
    "1099-5129",
    "1532-2092"
  ],
  "landing_url": "https://europepmc.org/article/MED/42905915",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Cardiac Arrhythmias and Treatments"
    ]
  ],
  "openalex": "W7223088959",
  "pdf_url": "https://europepmc.org/articles/PMC13685804?pdf=render",
  "pmcid": "PMC13685804",
  "pmid": "42905915",
  "published": "2026-10-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7q90bsrx6qrk6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42905915",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42905915"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac Arrhythmias and Treatments",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Pulsed field ablation: from concepts to technology.",
  "title_text": "Pulsed field ablation: from concepts to technology.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/7q90bsrx6qrk6",
  "venue": "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",
  "versions": []
}