Pulsed Field Ablation for Atrial Fibrillation: Early Experience in Brazil

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and represents a significant public health burden because it is independently associated with impaired quality of life, increased risk of stroke, and all-cause mortality⁽¹⁾. The incidence and prevalence of AF are growing worldwide, driven mainly by population aging and the rising prevalence of cardiovascular comorbidities. Together, these findings explain the economic impact of AF and its role as a growing healthcare challenge.

Catheter ablation is a well-established rhythm-control strategy for AF, with pulmonary vein isolation as its central component, since pulmonary vein–related triggers were recognized. Over more than two decades, advances in electroanatomic mapping, catheter technology, and energy delivery have improved the safety and long-term outcomes of radiofrequency and cryoballoon ablation. Despite these advances, single-procedure success remains limited, and complications related to collateral thermal injury can occur. Pulsed field ablation (PFA) has recently emerged as a novel, nonthermal ablation modality based on electroporation, induced by rapid electrical pulses that selectively ablate myocardial tissue while minimizing injury to adjacent structures such as the esophagus and phrenic nerve. Early clinical studies and real-world registries have demonstrated a favorable safety profile and efficacy comparable to thermal ablation.^– However, optimizing protocols and obtaining robust long-term outcome data remain necessary, especially in low- and middle-income countries such as Brazil.

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