Europace. 2026 Oct 21;28(Supplement_2):ii128-ii142. doi: 10.1093/europace/euag210.

ABSTRACT

Pulsed field ablation (PFA) has rapidly emerged as a major development in catheter ablation, with increasing clinical adoption driven by procedural efficiency and a favorable safety profile compared with thermal energies. This article summarizes the future directions of PFA in electrophysiology, focusing on technological innovation, and how these advances are expected to expand PFA clinical indications. Additionally, this article provides a perspective on current gaps and future challenges of PFA. A perspective on future developments in new waveforms, catheter architectures, and integration with electroanatomical mapping systems for PFA is summarized. The document discusses novel waveform configurations and catheter design concepts that may improve lesion quality, procedural versatility, and safety. Additionally, this article also reviews how parallel advances in electroanatomical mapping integration, artificial intelligence, and robotic navigation are expected to enhance procedural guidance and enable individualized therapy. This manuscript summarizes the potential applications of PFA beyond pulmonary vein isolation and how emerging evidence supports its feasibility for linear atrial lesions, substrate modification, treatment of complex atrial tachycardias, and ventricular arrhythmia ablation. In addition, this article provides insights on how PFA may facilitate catheter ablation in new patient populations including elderly patients and those with higher procedural risks. Finally, this manuscript provides an outlook at major remaining challenges and knowledge gaps for PFA. The lack of homogenous procedural endpoints definitions and lesion durability assessment are discussed. Furthermore, this article highlights the need for standardized terminology and reporting in an environment where the high heterogeneity between available commercial systems complicates comparison across technologies.

PMID:42905910 | DOI:10.1093/europace/euag210