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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

Pulsed field ablation: from concepts to technology.

  • Ante Anić1
  • Antoni Ivorra2
  • Brendan Koop3
  • Nathan J Kirkpatrick3
  • Jacob Koruth4
4 affiliations
  1. 1Department of Cardiovascular Disease, University Clinical Hospital, Split, Croatia.
  2. 2Department of Engineering, Universitat Pompeu Fabra, Barcelona, Spain.
  3. 3Department of Electrophysiology, Boston Scientific Corporation, 4100 Hamline Ave. N, St. Paul, MN 55112, USA.
  4. 4Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY, USA.
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Abstract

Aims

Pulsed 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

This 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.Conclusions

The 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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Cite

BibTeXRIS
BibTeX
@article{anic2026pulsed,
  title = {{Pulsed field ablation: from concepts to technology.}},
  author = {Ante Anić and Antoni Ivorra and Brendan Koop and Nathan J Kirkpatrick and Jacob Koruth},
  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/euag205},
  url = {https://europepmc.org/article/MED/42905915},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Pulsed field ablation: from concepts to technology.
AU  - Ante Anić
AU  - Antoni Ivorra
AU  - Brendan Koop
AU  - Nathan J Kirkpatrick
AU  - Jacob Koruth
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/euag205
UR  - https://europepmc.org/article/MED/42905915
AB  - Aims  Pulsed 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  This 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.Conclusions  The 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.
SN  - 1099-5129
SN  - 1532-2092
ER  -