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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

Safety considerations and clinical monitoring during pulsed field ablation.

  • Pascal Defaye1
  • Edward P Gerstenfeld2
  • Melanie A Gunawardene3,4,5
  • Jose L Merino6,7
  • Jose M Guerra8
  • Sandrine Venier1
  • Savannah Bifulco9
  • Andrea Sarkozy10
10 affiliations
  1. 1Arrhythmia Department/Cardiology Department, University Hospital of Grenoble Alpes, Avenue des Maquis du Grésivaudan, CS 10217, Grenoble 38043, France.
  2. 2Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco, 500 Parnassus Ave, San Francisco, CA 94143, USA.
  3. 3CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital, Wilhelm Epstein Strasse 4, Frankfurt am Main 60431, Germany.
  4. 4Centre for Heart Rhythm Disorders, Adelaide University and Royal Adelaide Hospital, Adelaide, SA, Australia.
  5. 5University Hospital Giessen, Department of Cardiology, Giessen, Germany.
  6. 6Arrhythmia and Robotic Electrophysiology Unit, La Paz University Hospital, IdiPaz, Madrid, Spain.
  7. 7Hospital Memorial Publio Cordón, Department of Cardiology, Pozuelo Alarcón, Madrid, Spain.
  8. 8Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain.
  9. 9Department of Electrophysiology, Boston Scientific, 4100 Hamline Ave N, St Paul, MN 55112, USA.
  10. 10Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
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Abstract

Pulsed field ablation (PFA) has emerged as a transformative technology in cardiac electrophysiology, offering a potentially superior safety profile compared with thermal ablation due to its non-thermal mechanism of irreversible electroporation. Clinical experience confirms a substantial reduction in traditional complications such as pulmonary vein stenosis, atrio-oesophageal fistula, and permanent phrenic nerve injury, though PFA introduces a distinct spectrum of physiologic effects requiring consideration. Coronary vasospasm is the most characteristic phenomenon, ranging from transient, subclinical constriction to rare ischaemic or arrhythmic events; mitigation relies on coronary anatomical awareness, optimized lesion placement, and prophylactic vasodilators. Haemolysis, caused by red blood cell electroporation, varies with catheter design and pulse burden and is typically mild, though high exposure and inadequate hydration may rarely lead to acute kidney injury. Silent cerebral lesions could result from procedural and/or energy-related factors, including gas formation, air ingress, catheter manipulation, and anticoagulation management, with uncertain long-term clinical impact but opportunities for technique-driven reduction. Interactions between PFA and cardiac implantable electronic devices are system- and context-dependent, with monopolar configurations and catheter-lead proximity influencing the risk of transient interference and rare permanent damage.

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Cite

BibTeXRIS
BibTeX
@article{defaye2026safety,
  title = {{Safety considerations and clinical monitoring during pulsed field ablation.}},
  author = {Pascal Defaye and Edward P Gerstenfeld and Melanie A Gunawardene and Jose L Merino and Jose M Guerra and Sandrine Venier and Savannah Bifulco 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/euag248},
  url = {https://europepmc.org/article/MED/42905916},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Safety considerations and clinical monitoring during pulsed field ablation.
AU  - Pascal Defaye
AU  - Edward P Gerstenfeld
AU  - Melanie A Gunawardene
AU  - Jose L Merino
AU  - Jose M Guerra
AU  - Sandrine Venier
AU  - Savannah Bifulco
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/euag248
UR  - https://europepmc.org/article/MED/42905916
AB  - Pulsed field ablation (PFA) has emerged as a transformative technology in cardiac electrophysiology, offering a potentially superior safety profile compared with thermal ablation due to its non-thermal mechanism of irreversible electroporation. Clinical experience confirms a substantial reduction in traditional complications such as pulmonary vein stenosis, atrio-oesophageal fistula, and permanent phrenic nerve injury, though PFA introduces a distinct spectrum of physiologic effects requiring consideration. Coronary vasospasm is the most characteristic phenomenon, ranging from transient, subclinical constriction to rare ischaemic or arrhythmic events; mitigation relies on coronary anatomical awareness, optimized lesion placement, and prophylactic vasodilators. Haemolysis, caused by red blood cell electroporation, varies with catheter design and pulse burden and is typically mild, though high exposure and inadequate hydration may rarely lead to acute kidney injury. Silent cerebral lesions could result from procedural and/or energy-related factors, including gas formation, air ingress, catheter manipulation, and anticoagulation management, with uncertain long-term clinical impact but opportunities for technique-driven reduction. Interactions between PFA and cardiac implantable electronic devices are system- and context-dependent, with monopolar configurations and catheter-lead proximity influencing the risk of transient interference and rare permanent damage.
SN  - 1099-5129
SN  - 1532-2092
ER  -