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Abstract
Catheter ablation (CA) has become the mainstay therapy for the maintenance of sinus
rhythm in patients with atrial fibrillation (AF), with pulmonary vein isolation (PVI)
the most frequently used treatment strategy. Although several energy sources have
been tested (including radiofrequency, cryothermal and laser), these are not devoid
of safety issues and in many instances effectiveness is dependent on operator experience.
Pulsed field ablation (PFA) is a novel energy source by which high-voltage electric
pulses are used to create pores in the cellular membrane (i.e., electroporation),
leading to cellular death. The amount of energy required to produce irreversible electroporation
is highly tissue dependent. In consequence, a tailored protocol in which specific
targeting of the atrial myocardium is achieved while sparing adjacent tissues is theoretically
feasible, increasing the safety of the procedure. While large scale clinical trials
are lacking, current clinical evidence has demonstrated significant efficacy in achieving
durable PVI without ablation related adverse events.