{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:46:16Z","timestamp":1791974776521,"version":"4.4.0"},"reference-count":79,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Catheter ablation for tachyarrhythmias was first introduced in the early 1980s using direct\u2010current (DC) energy. Following the clinical introduction of radiofrequency (RF) ablation in the late 1980s, thermal ablation technologies became the foundation of catheter ablation because of their superior controllability, efficacy, and safety. In 2014, Wittkampf developed a DC\u2010energy\u2010delivery catheter system preventing electrical arcing, thereby initiating a modern \u201crevival of DC\u2010ablation\u201d based on catheter ablation using electroporation. Subsequent development of high\u2010voltage, short\u2010duration pulse\u2010train delivery led to the emergence of pulsed field ablation (PFA). Exposure of myocytes to high\u2010voltage electric fields induces reversible electroporation through nanoscale pore formation within the lipid bilayer, whereas higher electric\u2010field delivery produces irreversible electroporation, resulting in permanent membrane disruption, apoptosis, and durable lesion formation.<\/jats:p>\n                  <jats:p>PFA is regarded as a predominantly nonthermal and potentially tissue\u2010selective ablation modality. Nevertheless, clinical trials of pulmonary vein isolation for atrial fibrillation have demonstrated that PFA is noninferior to conventional thermal ablation strategies, although clear superiority\u2014other than shorter procedural times\u2014has not yet been established. Importantly, recent studies suggest that electrode\u2013tissue contact remains a critical determinant of durable lesion formation. Accumulating evidence indicates that PFA is associated with new complications not commonly observed with thermal ablation, including acute kidney injury, stroke, coronary vasospasm, myocardial ischemia, ventricular fibrillation, and sudden cardiac death. Although the mechanisms remain incompletely understood, hemolysis\u2010related injury induced by high\u2010voltage pulse delivery may represent an important contributing mechanism. Development of PFA systems capable of real\u2010time prediction of irreversible lesion size may be essential for optimizing both procedural efficacy and safety.<\/jats:p>","DOI":"10.1002\/joa3.70482","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:20:07Z","timestamp":1791372007000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Advantages and Pitfalls of Pulsed Field Ablation: How to Prevent\n                    <scp>ALH<\/scp>\n                    Syndrome"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9368-519X","authenticated-orcid":false,"given":"Hiroshi","family":"Nakagawa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic  Cleveland Ohio 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