The past, present and future of cardiac pulsed field ablation

doi:10.3877/cma.j.issn.2095-6568.2026.01.002

Abstract

Abstract:

As the most common sustained cardiac arrhythmia worldwide, atrial fibrillation is undergoing a transformative shift in catheter ablation therapy—from conventional thermal techniques, such as radiofrequency ablation and cryoablation, toward non-thermal technology, namely pulsed field ablation. Based on the principle of irreversible electroporation, pulsed field ablation employs high-voltage, short-duration electric fields to selectively disrupt myocardial cell membrane structures, achieving tissue-specific ablation while avoiding thermal injury-related complications.

Key words: Ablation technique, Pulsed electric field, Atrial fibrillation, Pulmonary vein, Electroporation

Xiaoxi Zhao, Ruxing Wang. The past, present and future of cardiac pulsed field ablation[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2026, 14(01): 11-18.

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References 58

[1]	Hättasch R, Tscholl V, Hindricks G, et al. European Society of Cardiology (ESC) Guidelines on atrial fibrillation 2024 : what is new and what is important?[J]. Herz, 2025, 50(1):3-7.
[2]	Katov L, Teumer Y, Bothner C, et al. Comparative analysis of real-world clinical outcomes of a novel pulsed field ablation system for pulmonary vein isolation: the prospective CIRCLE-PVI study[J]. J Clin Med, 2024, 13(23):7040.
[3]	Nair DG, Gomez T, De Potter T. VARIPULSE: A step-by-step guide to pulmonary vein isolation[J]. J Cardiovasc Electrophysiol, 2024, 35(9):1817-1827.
[4]	Duytschaever M, Račkauskas G, De Potter T, et al. Dual energy for pulmonary vein isolation using dual-energy focal ablation technology integrated with a three-dimensional mapping system: SmartfIRE 3-month results[J]. Europace, 2024, 26(5):euae088.
[5]	Schiavone M, Solimene F, Moltrasio M, et al. Pulsed field ablation technology for pulmonary vein and left atrial posterior wall isolation in patients with persistent atrial fibrillation[J]. J Cardiovasc Electrophysiol, 2024, 35(6):1101-1111.
[6]	Neumann E, Rosenheck K. Permeability changes induced by electric impulses in vesicular membranes[J]. J Membr Biol, 1972, 10(3):279-290.
[7]	唐闽. 脉冲电场消融治疗心房颤动[J/OL].中华心脏与心律电子杂志, 2022, 10(1):27-31.
[8]	Maor E, Sugrue A, Witt C, et al. Pulsed electric fields for cardiac ablation and beyond: a state-of-the-art review[J]. Heart Rhythm, 2019, 16(7):1112-1120.
[9]	Gross D, Loew LM, Webb WW. Optical imaging of cell membrane potential changes induced by applied electric fields[J]. Biophys J, 1986, 50(2):339-348.
[10]	Batista Napotnik T, Polajžer T, Miklavčič D. Cell death due to electroporation - a review[J]. Bioelectrochemistry, 2021, 141:107871.
[11]	Chun KJ, Miklavčič D, Vlachos K, et al. State-of-the-art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective[J]. Europace, 2024, 26(6):euae134.
[12]	Muralidharan A, Rems L, Kreutzer MT, et al. Actin networks regulate the cell membrane permeability during electroporation[J]. Biochim Biophys Acta Biomembr, 2021, 1863(1):183468.
[13]	Kotnik T, Rems L, Tarek M, et al. Membrane electro- poration and electropermeabilization: mechanisms and models[J]. Annu Rev Biophys, 2019, 48:63-91.
[14]	Rems L, Viano M, Kasimova MA, et al. The contribution of lipid peroxidation to membrane permeability in electropermeabilization: a molecular dynamics study[J]. Bioelectrochemistry, 2019, 125:46-57.
[15]	Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation[J]. J Am Coll Cardiol, 2019, 74(3):315-326.
[16]	Jacobs EJ, Rubinsky B, Davalos RV. Pulsed field ablation in medicine: irreversible electroporation and electro- permeabilization theory and applications[J]. Radiol Oncol, 2025, 59(1):1-22.
[17]	Wittkampf FH, van Driel VJ, van Wessel H, et al. Feasibility of electroporation for the creation of pulmonary vein ostial lesions[J]. J Cardiovasc Electrophysiol, 2011, 22(3):302-309.
[18]	Reddy VY, Koruth J, Jais P, et al. Ablation of atrial fibrillation with pulsed electric fields: an ultra-rapid, tissue-selective modality for cardiac ablation[J]. JACC Clin Electrophysiol, 2018, 4(8):987-995.
[19]	Lavee J, Onik G, Mikus P, et al. A novel nonthermal energy source for surgical epicardial atrial ablation: irreversible electroporation[J]. Heart Surg Forum, 2007, 10(2):E162-E167.
[20]	Hong J, Stewart MT, Cheek DS, et al. Cardiac ablation via electroporation[J]. Annu Int Conf IEEE Eng Med Biol Soc, 2009, 2009:3381-3384.
[21]	van Driel VJ, Neven KG, van Wessel H, et al. Pulmonary vein stenosis after catheter ablation: electroporation versus radiofrequency[J]. Circ Arrhythm Electrophysiol, 2014, 7(4):734-738.
[22]	Koruth J, Kuroki K, Iwasawa J, et al. Preclinical evaluation of pulsed field ablation: electrophysiological and histological assessment of thoracic vein isolation[J]. Circ Arrhythm Electrophysiol, 2019, 12(12):e007781.
[23]	Yavin H, Shapira-Daniels A, Barkagan M, et al. Pulsed field ablation using a lattice electrode for focal energy delivery: biophysical characterization, lesion durability, and safety evaluation[J]. Circ Arrhythm Electrophysiol, 2020, 13(6):e008580.
[24]	Song Y, Zheng J, Fan L. Nonthermal irreversible electroporation to the esophagus: evaluation of acute and long-term pathological effects in a rabbit model[J]. J Am Heart Assoc, 2021, 10(22):e020731.
[25]	Im SI, Higuchi S, Lee A, et al. Pulsed field ablation of left ventricular myocardium in a swine infarct model[J]. JACC Clin Electrophysiol, 2022, 8(6):722-731.
[26]	Turagam MK, Neuzil P, Schmidt B, et al. Safety and effectiveness of pulsed field ablation to treat atrial fibrillation: one-year outcomes from the MANIFEST-PF registry[J]. Circulation, 2023, 148(1):35-46.
[27]	Reddy VY, Dukkipati SR, Neuzil P, et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II[J]. JACC Clin Electrophysiol, 2021, 7(5):614-627.
[28]	Ekanem E, Neuzil P, Reichlin T, et al. Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study[J]. Nat Med, 2024, 30(7):2020-2029.
[29]	Reddy VY, Gerstenfeld EP, Natale A, et al. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation[J]. N Engl J Med, 2023, 389(18):1660-1671.
[30]	Verma A, Boersma L, Haines DE, et al. First-in-human experience and acute procedural outcomes using a novel pulsed field ablation system: the PULSED AF pilot trial[J]. Circ Arrhythm Electrophysiol, 2022, 15(1):e010168.
[31]	Mekary W, Merchant FM. Pulsed field ablation for atrial fibrillation: moving the field forward?[J]. J Cardiovasc Electrophysiol, 2023, 34(10):2027-2028.
[32]	Li X, Huang L, Li J, et al. Tricuspid isthmus ablation with pulsed-field power by linear catheter: a case report[J]. Eur Heart J Case Rep, 2024, 8(1):ytad601.
[33]	Ruwald MH, Johannessen A, Worck R, et al. Feasibility and midterm effectiveness of focal pulsed field ablation for ventricular arrhythmias[J]. Heart Rhythm, 2025 :S1547-5271(25)00129-00128.
[34]	Muthu P, Prajapati P, Vemulapalli H, et al. Ablation of premature ventricular complexes originating from papillary muscle using pulsed field energy: the first in USA experience[J]. Heart Rhythm, 2024 :S1547-5271(24)03532-03532X.
[35]	Qiu J, Dai M, Bai Y, et al. Potential application of pulsed field ablation in ventricular arrhythmias[J]. Medicina (Kaunas), 2023, 59(4):723.
[36]	Mestrovic IP, Breskovic T, Markovic M, et al. Ablation of epicardial ventricular focus through coronary sinus using pulsed-field ablation. a case report[J]. J Cardiovasc Electrophysiol, 2024, 35(4):856-861.
[37]	Li F, Gong A, Hu H, et al. Pulsed field ablation of paroxysmal supraventricular tachycardia: a prospective multicenter single-arm study in China[J]. Circ Arrhythm Electrophysiol, 2024, 17(12):e013206.
[38]	沈才杰, 戴嘉挺, 贾振宇, 等. 脉冲电场消融对犬房室传导功能的影响[J/OL]. 中华心脏与心律电子杂志, 2023, 11(4):222-229.
[39]	Lozano-Granero C, Franco E, Matía-Francés R, et al. Electroporation saves the day again: pulsed-field ablation for phrenic nerve-sparing in right atrial tachycardia[J]. J Cardiovasc Electrophysiol, 2024, 35(10):2071-2075.
[40]	Zeng R, Li F, Jiang J, et al. The safety and feasibility of pulsed-field ablation in atrioventricular nodal re-entrant tachycardia: first-in-human pilot trial[J]. JACC Clin Electrophysiol, 2024, 10(1):82-92.
[41]	Neven K, van Es R, van Driel V, et al. Acute and long-term effects of full-power electroporation ablation directly on the porcine esophagus[J]. Circ Arrhythm Electrophysiol, 2017, 10(5):e004672.
[42]	Koruth JS, Kuroki K, Kawamura I, et al. Focal pulsed field ablation for pulmonary vein isolation and linear atrial lesions: a preclinical assessment of safety and durability[J]. Circ Arrhythm Electrophysiol, 2020, 13(6):e008716.
[43]	Zhao Z, Chen Y, Wu B, et al. Pulsed-field ablation using a novel ablation-mapping integrated system for pulmonary vein isolation-a preliminary animal study[J]. J Cardiovasc Dev Dis, 2022, 9(12):425.
[44]	Hsu JC, Gibson D, Banker R, et al. In vivo porcine characterization of atrial lesion safety and efficacy utilizing a circular pulsed-field ablation catheter including assessment of collateral damage to adjacent tissue in supratherapeutic ablation applications[J]. J Cardiovasc Electrophysiol, 2022, 33(7):1480-1488.
[45]	Koruth J, Kawamura I, Dukkipati SR, et al. Preclinical assessment of the feasibility, safety and lesion durability of a novel 'single-shot' pulsed field ablation catheter for pulmonary vein isolation[J]. Europace, 2023, 25(4):1369-1378.
[46]	Cochet H, Nakatani Y, Sridi-Cheniti S, et al. Pulsed field ablation selectively spares the oesophagus during pulmonary vein isolation for atrial fibrillation[J]. Europace, 2021, 23(9):1391-1399.
[47]	Nies M, Watanabe K, Kawamura I, et al. Endocardial pulsed field ablation and the oesophagus: are atrio-oesophageal fistulas now history? [J]. Arrhythm Electrophysiol Rev, 2024, 13:e02.
[48]	Howard B, Haines DE, Verma A, et al. Characterization of phrenic nerve response to pulsed field ablation[J]. Circ Arrhythm Electrophysiol, 2022, 15(6):e010127.
[49]	Pansera F, Bordignon S, Bologna F, et al. Catheter ablation induced phrenic nerve palsy by pulsed field ablation-completely impossible? a case series[J]. Eur Heart J Case Rep, 2022, 6(9):ytac361.
[50]	Mansour M, Gerstenfeld EP, Patel C, et al. Pulmonary vein narrowing after pulsed field versus thermal ablation[J]. Europace, 2024, 26(2):euae038.
[51]	Reddy VY, Gerstenfeld EP, Natale A, et al. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation[J]. N Engl J Med, 2023, 389(18):1660-1671.
[52]	Reddy VY, Petru J, Funasako M, et al. Coronary arterial spasm during pulsed field ablation to treat atrial fibrillation[J]. Circulation, 2022, 146(24):1808-1819.
[53]	Venier S, Vaxelaire N, Jacon P, et al. Sever acute kidney injury related to haemolysis after pulsed filed ablation for atrial fibrillation[J]. Europace, 2023, 26(1):euad371.
[54]	Mohanty S, Casella M, Compagnucci P, et al. Acute kidney injury resulting from hemoglobinuria after pulsed-field ablation in atrial fibrillation: is it preventable?[J]. JACC Clin Electrophysiol, 2024, 10(4):709-715.
[55]	Neven K, Füting A, Byrd I, et al. Absence of (sub-)acute cerebral events or lesions after electroporation ablation in the left-sided canine heart[J]. Heart Rhythm, 2021, 18(6):1004-1011.
[56]	Ekanem E, Reddy VY, Schmidt B, et al. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)[J]. Europace, 2022, 24(8):1256-1266.
[57]	Reinsch N, Füting A, Höwel D, et al. Cerebral safety after pulsed field ablation for paroxysmal atrial fibrillation[J]. Heart Rhythm, 2022, 19(11):1813-1818.
[58]	Iacopino S, Colella J, Dini D, et al. Sedation strategies for pulsed-field ablation of atrial fibrillation: focus on deep sedation with intravenous ketamine in spontaneous respiration[J]. Europace, 2023, 25(9):euad230.

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