Thus, do we care of energy source?
Therefore, assuming the extension of area of lesion is comparable between PFA and RF, could we foresee the same clinical behavior? Electroporation is characterized by a nonthermal energy source in which electrical fields are used to induce cardiomyocyte-specific cell death, thus avoiding adjacent anatomical structures (7). Initial clinical observations in controlled trials reported data on high degree of safety and acute efficacy and follow-up data of PFA-based PVI not significantly different from more conventional ablative therapy (8,9). On the other hand, the RFB is a compliant balloon catheter compatible with a 3D electroanatomical mapping system (CARTO 3, Biosense Webster, CA, USA) and provides an established energy source. One of the main advantages of this technology is the selective titration of RF energy delivery from each surface electrode to reduce collateral damage and to apply energy in a segmental area if needed (10). Multicenter trials (RADIANCE (10,11) and SHINE (12)) demonstrated the feasibility, safety, and 12-month outcome of this technology.
The wealth of clinical data collected from trials seems to indicate a comparable outcome between the two modalities of ablation but higher safety profile of electroporation over different energy sources ( especially RF current). How much crucial is the extension of area of ablation towards the posterior wall in affecting the durability of lesions produced is still unknown.
At the end of the day, we all dream to devise the most successful ablative approach as to ensure a stable regular sinus rhythm to our AF patients, but undoubtedly there still a need to gather additional insights into these two novel strategies of treatment before declaring the final winner.