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Peer-reviewedCC BYEuropace : 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

Treatment of paroxysmal and persistent atrial fibrillation with pulsed field ablation.

  • Serge Boveda1
  • Kyoung-Ryul Julian Chun2,3
  • Pierre Jais4,5,6
  • Nicolas Johner4,5
  • Claire A Martin7,8
  • Rami Daya9
  • Andrea Sarkozy10
10 affiliations
  1. 1Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31300 Toulouse, France.
  2. 2Klinik fur Rhythmologie, CCB am Markus Krankenhaus, Wilhelm-Epstein 4, 60431 Frankfurt, Germany.
  3. 3Klinik fur Rhythmologie, Universitatsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23548 Lubeck, Germany.
  4. 4Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Avenue de Magellan, 33600 Pessac, France.
  5. 5IHU LIRYC, IHU LIRYC Bordeaux University, Av. du Haut Leveque, 33600 Pessac, France.
  6. 6Cardiology Department, American Hospital of Paris, 84 Boulevard de la Saussaye, 92200 Neuilly-Sur-Seine, France.
  7. 7Department of Cardiology, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge CB2 0AY, United Kingdom.
  8. 8Department of Clinical Medicine, University of Cambridge, Trinity Lane, Cambridge CB2 1TN, United Kingdom.
  9. 9Rhythm Management Medical Affairs, Boston Scientific, Masaref Street, 13-6045 Beirut, Lebanon.
  10. 10Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Jette, Brussel, Belgium.
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{boveda2026treatment,
  title = {{Treatment of paroxysmal and persistent atrial fibrillation with pulsed field ablation.}},
  author = {Serge Boveda and Kyoung-Ryul Julian Chun and Pierre Jais and Nicolas Johner and Claire A Martin and Rami Daya and Andrea Sarkozy},
  journal = {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},
  year = {2026},
  month = oct,
  doi = {10.1093/europace/euag194},
  url = {https://europepmc.org/article/MED/42905913},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Treatment of paroxysmal and persistent atrial fibrillation with pulsed field ablation.
AU  - Serge Boveda
AU  - Kyoung-Ryul Julian Chun
AU  - Pierre Jais
AU  - Nicolas Johner
AU  - Claire A Martin
AU  - Rami Daya
AU  - Andrea Sarkozy
PY  - 2026
DA  - 2026/10/01
JO  - 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
DO  - 10.1093/europace/euag194
UR  - https://europepmc.org/article/MED/42905913
AB  - 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.
SN  - 1099-5129
SN  - 1532-2092
ER  -