The introduction of cryoablation and pulsed field ablation (PFA) into electrophysiology (EP) labs has expanded the toolkit for catheter-based treatment of atrial fibrillation and other arrhythmias by offering important advantages over traditional point-by-point radiofrequency ablation. The advantages of these new modalities include improved safety, efficiency, and reproducibility. Cryoablation produces sharply demarcated lesions while preserving the extracellular matrix and reducing thrombus risk and tissue disruption. The ‘cryomapping’ feature – temporary cooling to test effects before delivering irreversible injury – allows safer treatment near critical structures such as the atrioventricular node or when assessing phrenic nerve risk.
PFA uses short, high‑voltage electrical pulses to create irreversible electroporation – nanopores in cell membranes – leading to cell death. This technology is nonthermal and therefore not reliant on contact force and conduction for the creation of lesions. As a result, it can allow quicker and more precise interventions, with studies showing a significant reduction in collateral injuries to the oesophagus, phrenic nerve, and coronary arteries.
Both cryoablation and pulsed field ablation represent important tools in the evolving EP lab, each with distinct mechanisms, advantages, and implementation considerations. They represent complementary options for treating atrial fibrillation and other arrhythmias. As evidence accumulates and technology advances, thoughtful adoption, continued training, and rigorous outcome tracking will be essential to maximise patient benefit and safely integrate these modalities into routine practice.
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