Expert opinion of the Heart Rhythm Association of the Polish Cardiac Society on pulsed field ablation for atrial fibrillation

Pulsed field ablation (PFA) has emerged as an innovative non-thermal technique for the treatment of atrial fibrillation, offering a unique mechanism based on irreversible electroporation that selectively targets myocardial tissue while minimizing damage to surrounding structures. This expert opinion by the Heart Rhythm Association of the Polish Cardiac Society provides a comprehensive review of current evidence, practical experience, and recommendations for the implementation of PFA in Poland. The document summarizes the biophysical principles, clinical outcomes from major trials, safety profile, sedation strategies, device characteristics, and national experience since the technology's introduction. PFA demonstrates comparable efficacy and hope for superior safety compared to conventional radiofrequency and cryothermal ablation, with shorter procedure times and reduced collateral injury. However, unresolved issues remain, including long-term outcomes, optimal procedural protocols, and specific safety considerations such as hemolysis, silent cerebral lesions, and coronary spasm. The Polish experience supports the rapid adoption of PFA as a first-line ablation strategy for atrial fibrillation in appropriately equipped and experienced centers, with the need for ongoing research and standardization of procedural and anesthesia protocols.