Controlling pulsed field ablation efficacy during ablation procedures.
7 affiliations
- 1Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Department of Cardiology, Hospital Álvaro Cunqueiro, University of Vigo, Vigo, Spain.
- 2Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech - Emory University, Atlanta, GA, USA.
- 3Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- 4Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, Rotterdam, the Netherlands.
- 5Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
- 6Electrophysiology Department, Boston Scientific Corporation, Marlborough, MA, USA.
- 7Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Abstract
Pulsed field ablation (PFA) has rapidly emerged as a promising ablation modality for the treatment of cardiac arrhythmias because of its myocardial tissue preferential ablation and favourable safety profile. However, procedural control of lesion formation and reliable assessment of lesion durability remain important challenges. This review summarizes the main determinants of PFA efficacy and current approaches for intraprocedural lesion assessment. Experimental and clinical studies indicate that PFA lesion formation results from the interaction between delivered electrical energy, catheter design, tissue coupling, and application strategy. Lesion size and geometry are primarily determined by electric field distribution and cumulative electroporation exposure, while excessive energy delivery may induce unwanted thermal or electrochemical effects. Procedural efficacy also depends on stable catheter positioning, adequate tissue proximity, and sufficient lesion overlap. Unlike thermal ablation technologies, conventional procedural markers such as electrogram attenuation, impedance changes, and pacing threshold variation correlate poorly with durable irreversible electroporation. Multiparametric lesion estimation models integrating electrical, mechanical, and positional data have shown encouraging preclinical results, although clinical validation remains limited. Emerging strategies combining electroanatomical mapping, imaging, and automated electrogram analysis may improve real-time evaluation of lesion continuity and durability. Current PFA workflows rely mainly on standardized energy delivery protocols, optimized catheter positioning, and lesion overlap rather than real-time titration of energy. Although robust intraprocedural markers of irreversible electroporation are still lacking, ongoing advances in catheter technology, imaging, and lesion assessment tools are expected to improve procedural reproducibility and long-term lesion durability. Further studies are needed to establish validated endpoints for durable PFA lesion formation.
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BibTeX
@article{cesponfernandez2026controlling,
title = {{Controlling pulsed field ablation efficacy during ablation procedures.}},
author = {María Cespón-Fernández and Rafael V Davalos and Thomas Kueffer and Bakhtawar Khan Mahmoodi and Tobias Reichlin and Andrea Sarkozy and Sing-Chien Yap and Edward J Jacobs and Guillaume Gibert and Samuel J Asirvatham},
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/euag188},
url = {https://europepmc.org/article/MED/42905912},
note = {CC BY},
}
RIS
TY - JOUR
TI - Controlling pulsed field ablation efficacy during ablation procedures.
AU - María Cespón-Fernández
AU - Rafael V Davalos
AU - Thomas Kueffer
AU - Bakhtawar Khan Mahmoodi
AU - Tobias Reichlin
AU - Andrea Sarkozy
AU - Sing-Chien Yap
AU - Edward J Jacobs
AU - Guillaume Gibert
AU - Samuel J Asirvatham
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/euag188
UR - https://europepmc.org/article/MED/42905912
AB - Pulsed field ablation (PFA) has rapidly emerged as a promising ablation modality for the treatment of cardiac arrhythmias because of its myocardial tissue preferential ablation and favourable safety profile. However, procedural control of lesion formation and reliable assessment of lesion durability remain important challenges. This review summarizes the main determinants of PFA efficacy and current approaches for intraprocedural lesion assessment. Experimental and clinical studies indicate that PFA lesion formation results from the interaction between delivered electrical energy, catheter design, tissue coupling, and application strategy. Lesion size and geometry are primarily determined by electric field distribution and cumulative electroporation exposure, while excessive energy delivery may induce unwanted thermal or electrochemical effects. Procedural efficacy also depends on stable catheter positioning, adequate tissue proximity, and sufficient lesion overlap. Unlike thermal ablation technologies, conventional procedural markers such as electrogram attenuation, impedance changes, and pacing threshold variation correlate poorly with durable irreversible electroporation. Multiparametric lesion estimation models integrating electrical, mechanical, and positional data have shown encouraging preclinical results, although clinical validation remains limited. Emerging strategies combining electroanatomical mapping, imaging, and automated electrogram analysis may improve real-time evaluation of lesion continuity and durability. Current PFA workflows rely mainly on standardized energy delivery protocols, optimized catheter positioning, and lesion overlap rather than real-time titration of energy. Although robust intraprocedural markers of irreversible electroporation are still lacking, ongoing advances in catheter technology, imaging, and lesion assessment tools are expected to improve procedural reproducibility and long-term lesion durability. Further studies are needed to establish validated endpoints for durable PFA lesion formation.
SN - 1099-5129
SN - 1532-2092
ER -