心房颤动脉冲电场消融的围手术期管理:聚焦新技术,优化全流程OA

Pulsed field ablation(PFA),as a non-thermal,tissue-selective ablation technique,has emerged as a revolutionary novel platform in the field of catheter ablation for atrial fibrillation.It induces irreversible electroporation via high-voltage pulsed electric fields,leading to cardiomyocyte apoptosis,while adjacent tissues such as the esophagus,blood vessels,and nerves are preserved to the maximum extent possible.This unique mechanism enables PFA to achieve efficient pulmonary vein isolation(PVI)while significantly reducing the risk of complications associated with conventional thermal ablation modalities(i.e.,radiofrequency and cryoablation).Nevertheless,the introduction of this novel technology has also brought about new and unique potential risks,including acute hemolysis,coronary artery spasm,and subclinical cerebral injury.Therefore,perioperative management of PFA must not only adhere to routine principles but also be subject to refined adjustments tailored to the physical characteristics of PFA.Based on the latest evidence and clinical experience,this article aims to systematically elaborate on the key aspects of the entire process of perioperative management of PFA in atrial fibrillation,with a particular focus on the monitoring,prevention,and treatment of its specific complications,so as to promote the safe and standardized application of this technology.