PULSE-ELECTRICAL ABLATION IN ATRIAL FIBRILLATION: EFFICACY AND SAFETY ACCORDING TO CURRENT RANDOMIZED TRIALS AND META-ANALYSES 2025–2026

Atrial fibrillation (AF) is the most common persistent cardiac arrhythmia and is associated with an increased risk of stroke, heart failure, hospitalizations, and cardiovascular mortality. Catheter pulmonary vein isolation (PVI) is central to the current rhythm control strategy in patients with symptomatic AF, especially when antiarrhythmic therapy is ineffective or intolerant. Traditionally, thermal methods have been used to perform PVI, primarily radiofrequency (RF) and cryoballoon ablation. Despite the proven effectiveness of these technologies, their use is associated with the risk of damage to surrounding tissues, including the esophagus, phrenic nerve and coronary arteries.Pulsed field ablation (PFA) is a fundamentally new method of catheter ablation based on the use of short, high-voltage electrical pulses that cause irreversible electroporation of cell membranes. The presumed tissue selectivity of electroporation may provide preferential damage to cardiomyocytes with relative preservation of surrounding structures. This has the potential to reduce the risk of some of the complications associated with thermal ablation while reducing the duration of the procedure.