Pulsed electric fields for cardiac ablation and beyond: A state-of-the-art review

Irreversible electroporation (IRE) occurs when a strong, pulsed electric field (PEF) causes permeabilization of the cell membrane, leading to cellular homeostasis disruption and cell death. IRE is a Food and Drug Administration–approved treatment of tumor ablation and has been gaining attention in cardiology as an ablation modality. Applications of PEF in cardiology are vast and include atrial fibrillation, ventricular fibrillation, septal ablation, and targeting vascular structures. PEF has appealing characteristics, including the ability to be tissue specific and its nonthermal nature. This review provides information on the biophysics and mechanisms of IRE, summarizes key studies and applications to date, and provides insight into future applications.