The future of PFA in cardiac ablation procedures.
11 affiliations
- 1Department of Medicine, Vancouver General Hospital, Vancouver, Canada.
- 2Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
- 3Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
- 4Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France.
- 5IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Bordeaux-Pessac, France.
- 6Arrhythmia Center for the Capital Region of Denmark, Rigshospitalet and Gentofte Hospital, Copenhagen, Denmark.
- 7Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany.
- 8Department of Medicine, Witten/Herdecke University, Witten, Germany.
- 9Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
- 10Medical Education-Boston Scientific Corporation EMEA, Madrid, Spain.
- 11Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, USA.
Abstract
Pulsed field ablation (PFA) has rapidly emerged as a major development in catheter ablation, with increasing clinical adoption driven by procedural efficiency and a favorable safety profile compared with thermal energies. This article summarizes the future directions of PFA in electrophysiology, focusing on technological innovation, and how these advances are expected to expand PFA clinical indications. Additionally, this article provides a perspective on current gaps and future challenges of PFA. A perspective on future developments in new waveforms, catheter architectures, and integration with electroanatomical mapping systems for PFA is summarized. The document discusses novel waveform configurations and catheter design concepts that may improve lesion quality, procedural versatility, and safety. Additionally, this article also reviews how parallel advances in electroanatomical mapping integration, artificial intelligence, and robotic navigation are expected to enhance procedural guidance and enable individualized therapy. This manuscript summarizes the potential applications of PFA beyond pulmonary vein isolation and how emerging evidence supports its feasibility for linear atrial lesions, substrate modification, treatment of complex atrial tachycardias, and ventricular arrhythmia ablation. In addition, this article provides insights on how PFA may facilitate catheter ablation in new patient populations including elderly patients and those with higher procedural risks. Finally, this manuscript provides an outlook at major remaining challenges and knowledge gaps for PFA. The lack of homogenous procedural endpoints definitions and lesion durability assessment are discussed. Furthermore, this article highlights the need for standardized terminology and reporting in an environment where the high heterogeneity between available commercial systems complicates comparison across technologies.
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BibTeX
@article{andrade2026future,
title = {{The future of PFA in cardiac ablation procedures.}},
author = {Jason G Andrade and Samuel J Asirvatham and Mélèze Hocini and Peter Karl Jacobsen and Nico Reinsch and Domenico G Della Rocca and Andrea Sarkozy and Nicholas Tan and Jason A Tri and Claudia Auricchio and Giovanni Raciti and Tomás García-Sánchez 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/euag210},
url = {https://europepmc.org/article/MED/42905910},
note = {CC BY},
}
RIS
TY - JOUR
TI - The future of PFA in cardiac ablation procedures.
AU - Jason G Andrade
AU - Samuel J Asirvatham
AU - Mélèze Hocini
AU - Peter Karl Jacobsen
AU - Nico Reinsch
AU - Domenico G Della Rocca
AU - Andrea Sarkozy
AU - Nicholas Tan
AU - Jason A Tri
AU - Claudia Auricchio
AU - Giovanni Raciti
AU - Tomás García-Sánchez
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/euag210
UR - https://europepmc.org/article/MED/42905910
AB - Pulsed field ablation (PFA) has rapidly emerged as a major development in catheter ablation, with increasing clinical adoption driven by procedural efficiency and a favorable safety profile compared with thermal energies. This article summarizes the future directions of PFA in electrophysiology, focusing on technological innovation, and how these advances are expected to expand PFA clinical indications. Additionally, this article provides a perspective on current gaps and future challenges of PFA. A perspective on future developments in new waveforms, catheter architectures, and integration with electroanatomical mapping systems for PFA is summarized. The document discusses novel waveform configurations and catheter design concepts that may improve lesion quality, procedural versatility, and safety. Additionally, this article also reviews how parallel advances in electroanatomical mapping integration, artificial intelligence, and robotic navigation are expected to enhance procedural guidance and enable individualized therapy. This manuscript summarizes the potential applications of PFA beyond pulmonary vein isolation and how emerging evidence supports its feasibility for linear atrial lesions, substrate modification, treatment of complex atrial tachycardias, and ventricular arrhythmia ablation. In addition, this article provides insights on how PFA may facilitate catheter ablation in new patient populations including elderly patients and those with higher procedural risks. Finally, this manuscript provides an outlook at major remaining challenges and knowledge gaps for PFA. The lack of homogenous procedural endpoints definitions and lesion durability assessment are discussed. Furthermore, this article highlights the need for standardized terminology and reporting in an environment where the high heterogeneity between available commercial systems complicates comparison across technologies.
SN - 1099-5129
SN - 1532-2092
ER -