Prof. Michael Kühne, University Hospital Basel, Switzerland
Prof. Helmut Pürerfellner, Ordensklinikum Linz Elisabethinen, Austria
PD Dr. Patrick Badertscher, University Hospital Basel, Switzerland
What is the reason for and aim of the publication?
The publication was motivated by the rapid emergence and global adoption of pulsed field ablation (PFA) as a novel technology for the treatment of atrial fibrillation. While early clinical data are highly promising, there has been a lack of comprehensive, practical guidance on how to use this technology safely and effectively. The aim of this scientific statement was therefore to provide an overview of the underlying principles, current evidence, procedural aspects, and training requirements, while supporting a standardized and safe implementation of PFA in clinical practice.
What are the most important take-home messages?
- PFA represents a major innovation in AF ablation with a distinct, non-thermal mechanism of action.
- It offers comparable efficacy to conventional ablation techniques, with a potentially improved safety profile, particularly regarding collateral tissue injury.
- Procedural workflows may be simplified, enabling shorter procedures and streamlined patient management.
- However, PFA remains a complex electrophysiological intervention that requires appropriate expertise and should not be considered a simplified or “plug-and-play” technology.
- Structured training and careful clinical implementation are essential to ensure safe and effective use.
What are challenges in practical implementation – and possible solutions?
One of the main challenges is the heterogeneity of currently available PFA technologies, including different catheter designs and energy delivery systems, which makes standardization difficult. Another important issue is the risk of underestimating the complexity of the procedure. Despite its apparent simplicity, successful PFA requires a solid understanding of electrophysiology, anatomy, and procedural endpoints. Solutions include structured training pathways, implementation in experienced electrophysiology centres, adherence to device-specific protocols, and participation in registries to monitor outcomes and ensure quality of care.
Which issues still need to be tackled, that are not yet addressed by the paper?
Several key questions remain unanswered, including long-term efficacy and durability beyond one year, optimal ablation strategies in persistent atrial fibrillation, and the best approaches for lesion assessment and dosing. In addition, more data are needed to better understand device-specific risks and to compare different PFA platforms.
What further developments on the topic are emerging?
The field is evolving rapidly, with ongoing technological innovation, including new catheter designs, dual-energy systems, and integration with advanced mapping technologies.
At the same time, clinical research is expanding, with numerous ongoing trials investigating the role of PFA in different patient populations and more complex ablation strategies. In the future, PFA is expected to play a central role in a more personalized and technology-driven approach to atrial fibrillation treatment.
Pulsed Field Ablation for the Interventional Treatment of Atrial Fibrillation
Michael Kühne, Patrick Badertscher, Jason G Andrade et al. Pulsed Field Ablation for the Interventional Treatment of Atrial Fibrillation. A Scientific Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS) and the Canadian Heart Rhythm Society (CHRS), EP Europace, 2026;, euag080, https://doi.org/10.1093/europace/euag080.
Document types published by the ESC, Associations, Councils, Working Groups, and ESC Committees (according to the ESC Scientific Documents Policy):
