Pulsed Field Ablation for Atrial Fibrillation: Contemporary Clinical Evidence and Real-World Experience in Redo Ablation

Atrial fibrillation (AF) is the most common prevalent sustained arrhythmia and is associated with stroke, heart failure, and impaired health-related quality of life. Due to the complexity of the initiation and the persistence of AF, the pulmonary vein isolation (PVI) using thermal or laser energy is the most commonly applied ablation strategy. However, these thermal ablation modalities have several limitations, including a substantial risk of AF recurrence and collateral damage to tissues adjacent to the heart. Pulsed field ablation (PFA) is a novel non-thermal ablation technique in which high-voltage electric fields deliver short pulses, selectively affecting cardiomyocyte cell membranes. PFA has the potential to create myocardial lesions with minimal harm to non-cardiac tissues. Clinical studies have evaluated the safety and efficacy of PFA, examining its ability to prevent AF recurrence and its impact on surrounding structures, often in comparison with conventional PVI approaches. In this review, PFA clinical studies are discussed as well as our experience with the PFA use for redo atrial fibrillation ablation cases.