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Clinical experience confirms a substantial reduction in traditional complications such as pulmonary vein stenosis, atrio-oesophageal fistula, and permanent phrenic nerve injury, though PFA introduces a distinct spectrum of physiologic effects requiring consideration. Coronary vasospasm is the most characteristic phenomenon, ranging from transient, subclinical constriction to rare ischaemic or arrhythmic events; mitigation relies on coronary anatomical awareness, optimized lesion placement, and prophylactic vasodilators. Haemolysis, caused by red blood cell electroporation, varies with catheter design and pulse burden and is typically mild, though high exposure and inadequate hydration may rarely lead to acute kidney injury. Silent cerebral lesions could result from procedural and\/or energy-related factors, including gas formation, air ingress, catheter manipulation, and anticoagulation management, with uncertain long-term clinical impact but opportunities for technique-driven reduction. Interactions between PFA and cardiac implantable electronic devices are system- and context-dependent, with monopolar configurations and catheter-lead proximity influencing the risk of transient interference and rare permanent damage.<\/jats:p>","DOI":"10.1093\/europace\/euag248","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:52:58Z","timestamp":1792597978000},"page":"ii67-ii81","source":"Crossref","is-referenced-by-count":0,"title":["Safety considerations and clinical monitoring during pulsed field ablation"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7183-4278","authenticated-orcid":false,"given":"Pascal","family":"Defaye","sequence":"first","affiliation":[{"name":"Arrhythmia Department\/Cardiology Department, University Hospital of Grenoble Alpes , Avenue des Maquis du Gr\u00e9sivaudan, CS 10217, Grenoble 38043 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward P","family":"Gerstenfeld","sequence":"additional","affiliation":[{"name":"Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco , 500 Parnassus Ave, San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7561-7185","authenticated-orcid":false,"given":"Melanie A","family":"Gunawardene","sequence":"additional","affiliation":[{"name":"CCB, MVZ CCB Frankfurt und Main Taunus GbR, Markus Hospital , Wilhelm Epstein Strasse 4, Frankfurt am Main 60431 ,","place":["Germany"]},{"name":"Centre for Heart Rhythm Disorders, Adelaide University and Royal Adelaide Hospital , Adelaide, SA ,","place":["Australia"]},{"name":"University Hospital Giessen, Department of Cardiology , Giessen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1737-1903","authenticated-orcid":false,"given":"Jose L","family":"Merino","sequence":"additional","affiliation":[{"name":"Arrhythmia and Robotic Electrophysiology Unit, La Paz University Hospital, IdiPaz , Madrid ,","place":["Spain"]},{"name":"Hospital Memorial Publio Cord\u00f3n , Department of Cardiology, Pozuelo Alarc\u00f3n, Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5397-9177","authenticated-orcid":false,"given":"Jose M","family":"Guerra","sequence":"additional","affiliation":[{"name":"Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), CIBERCV, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1129-5089","authenticated-orcid":false,"given":"Sandrine","family":"Venier","sequence":"additional","affiliation":[{"name":"Arrhythmia Department\/Cardiology Department, University Hospital of Grenoble Alpes , Avenue des Maquis du Gr\u00e9sivaudan, CS 10217, Grenoble 38043 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6679-6716","authenticated-orcid":false,"given":"Savannah","family":"Bifulco","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Boston Scientific , 4100 Hamline Ave N, St Paul, MN 55112 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-0487","authenticated-orcid":false,"given":"Andrea","family":"Sarkozy","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, 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