A Reflection on Cardiac Ablation Energy Sources

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EP LAB DIGEST. 2023;23(11):6.

Dear Readers,

Pulsed field ablation (PFA) will likely be commercially available in the United States within the next few months. Despite the absence of PFA clinical trial data showing superior outcomes compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA) for pulmonary vein isolation (PVI), it is likely that electrophysiologists will be eager to use PFA to reduce procedure time, allow for extensive posterior left atrial wall ablation, and avoid very rare but catastrophic complications related to collateral injury to the PVs, esophagus, and phrenic nerve. Laser energy sources are also commercially available in the United States, but laser ablation is limited to the laser balloon for PVI and has limited use. Now is an important time to consider the pros and cons of these energy sources as the field moves forward.

The table below is a summary of the pros and cons of RFA, CBA, and PFA as energy sources for cardiac ablation.

Disclosures: Dr Knight has served as a paid consultant to Medtronic and was an investigator in the PULSED AF trial. In addition, he has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AltaThera, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Philips, and Sanofi; he has no equity or ownership in any of these companies.