Perspective:

Pulsed electrical field ablation results in irreversible electroporation of myocardial cells. PFA has several potential advantages over radiofrequency (heat)/cryothermy–based ablation systems: it relies on proximity of the energy source to the target as opposed to intimate contact; it is more efficient than point-by-point radiofrequency ablation techniques, and likely cryoballoon-based procedures; it is less likely to result in collateral damage to the phrenic nerve, esophagus, and coronary arteries based on myocardial tissue selectivity; and minimal heat generation during PFA should result in lower incidence of overheating phenomena such as charring/thromboembolism and steam pops/perforation. The electrophysiology community eagerly awaits the long-term clinical data in a larger sample size to determine the durability and clinical efficacy of pulsed electrical field–guided PV isolation for atrial fibrillation.