脉冲电场消融的诞生与演化OA

Pulsed field ablation(PFA)is a novel non-thermal ablation technology emerging based on electroporation instead of appearing abruptly.Its evolution can be summarized in several major stages,including the establishment of electroporation theory,the development of irreversible electroporation(IRE)as a tissue ablation modality,its translation into cardiac electrophysiology,and its clinical application and evidence elevation in catheter ablation for atrial fibrillation(AF).Since 2018,PFA has progressed from first-in-human application to expanded use in persistent AF and,subsequently,to validation in randomized controlled trials,and it has now become one of the most representative emerging energy platforms in AF ablation.At the same time,with broader clinical adoption and accumulation of real-world experience,the understanding of PFA has evolved from an early emphasis on its non-thermal nature,procedural efficiency and relative safety to a more comprehensive recognition of its unique complication profile and mechanistic foundation,including coronary artery spasm,hemolysis-related acute kidney injury,and mild thermal effects.This review summarizes the background of PFA development,key technological milestones,evolution of clinical evidence,and recent real-world advances,with the aim of providing a reference for understanding its current clinical positioning and future development directions.