Pulsed Field Ablation for the Interventional Treatment of Cardiac Arrhythmias

Pulsed field ablation is a recent addition to the energies used to ablate cardiac arrhythmias. Despite its recent introduction in the clinical field, pulsed field ablation exploits the well-known phenomenon of irreversible electroporation and the less known phenomena underlying the induced selective cell death. Far from being only used in cardiology, irreversible electroporation is mainly exploited in the treatment of solid tumors and in food industry. Nevertheless, the tissue specificity of the technique with respect to muscular cells presented such a favorable benefits-to-risk ratio that fundamental questions (e.g., What causes cell death? Can we model it to predict the ablation lesion?) were put on hold in favor of preclinical testing and first clinical applications. In this chapter, we explore the current knowledge of irreversible electroporation mechanisms and their modeling, keeping our focus on the research that created the basis of application, and the one that is setting the roadmap for pulsed field ablation in its promise to revolutionize the interventional treatment of arrhythmia.