Dosing of single-shot pulsed field ablation systems: A systematic review of efficacy and safety balance.

Pulsed field ablation (PFA) is emerging as an alternative to thermal ablation for pulmonary vein isolation (PVI) in atrial fibrillation, although PFA-specific complications have arisen. This review provides an overview of the efficacy and safety of single-shot PFA systems. Of 804 PubMed studies (January 14, 2026), 47 primary PVI studies were included. All PFA systems reported almost 100% acute PVI. The multispline, circular, and spherical catheters showed significant changes in hemolysis biomarkers. However, acute kidney injury occurred only with the pentaspline (n = 39 of 1307) and variable-loop catheters (n = 4 of 122). Myocardial injury biomarkers significantly increased in the multispline, circular, and spherical catheters. Hemolysis, acute kidney injury, and myocardial injury were all linked to more applications. 6-12 months of arrhythmia-free survival was 55%-88% for both the multispline and circular catheters and 77%-88% for the spherical catheters. Comparison is difficult owing to the heterogeneity of systems. Prospective trials are needed to optimize PFA dosing, balancing efficacy and safety.