Pašara Vedran, Sattin Tommaso, De Asmundis Carlo, Chierchia Gian-Battista, Bala Gezim
Heart Rhythm Management Centre, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel Heart Rhythm Research Brussels, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia.
Expert Rev Med Devices. 2025 Apr;22(4):311-320. doi: 10.1080/17434440.2025.2475239. Epub 2025 Mar 6.
Atrial fibrillation is the most common sustained arrhythmia, associated with substantial morbidity and a reduced quality of life. The current standard of care, transcatheter pulmonary vein isolation using thermal ablation techniques, provides symptom relief but carries a risk of collateral tissue damage. In recent years, pulsed field ablation, a nonthermal technique based on irreversible electroporation, has emerged as a promising alternative to conventional thermal ablation methods.
This review provides an overview of pulsed field ablation, a novel nonthermal ablation technique. We briefly explain its biophysical principles and general technical aspects, describe currently available technologies, and summarize findings from clinical studies. Additionally, we discuss its safety profile, unresolved issues, and limitations, while also exploring future perspectives.
Pulsed field ablation offers distinct advantages over traditional thermal ablation methods, such as shorter procedure times and a favorable safety profile due to precise tissue targeting. Future improvements in ablation device design, energy delivery settings, integration with mapping systems, workflow efficiency, ablation protocols, and patient selection criteria are expected to further enhance clinical outcomes.
心房颤动是最常见的持续性心律失常，与严重的发病率和生活质量下降相关。目前的治疗标准，即使用热消融技术进行经导管肺静脉隔离，可缓解症状，但存在附带组织损伤的风险。近年来，脉冲场消融作为一种基于不可逆电穿孔的非热技术，已成为传统热消融方法的一种有前景的替代方法。
本综述概述了脉冲场消融这一新型非热消融技术。我们简要解释其生物物理原理和一般技术方面，描述目前可用的技术，并总结临床研究结果。此外，我们讨论其安全性、未解决的问题和局限性，同时也探索未来前景。
与传统热消融方法相比，脉冲场消融具有明显优势，如手术时间更短，且由于精确的组织靶向而具有良好的安全性。预计消融设备设计、能量输送设置、与标测系统的整合、工作流程效率、消融方案和患者选择标准等方面的未来改进将进一步提高临床疗效。
