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Problems with both efficacy and risk are raised with ablation of atrial fibrillation (AF), although these have improved over time. A novel nonthermal modality with possibly greater efficacy and safety is pulsed field ablation (PFA), which kills cells by creating nanoscale pores in cell membranes. PFA has a theoretical advantage in that myocardial cells appear to be more susceptible to injury and death than other cell types, including fibroblasts, nerve tissue, and the esophagus. A research group has now reported on two similar sequential, industry-sponsored trials of PFA with 81 patients who had paroxysmal AF (NCT03700385 and NCT03714178).
The study design involved sequential changing of the energy used depending on the results with the prev…