Atrial fibrillation, manifested by an irregular heartbeat, is the most common form of arrhythmia leading to medical consultation and a major public health problem due to its high morbidity and mortality. This is mainly due to the cerebrovascular attacks it causes, but also to the deterioration of heart function which can lead to various stages of heart failure. Also, atrial fibrillation often impairs the quality of life due to the intense symptoms caused by the large fluctuations in heart rate.

Therefore, it becomes extremely important:

• the correct use of anticoagulant drugs for the prevention of strokes which has been simplified since the introduction of newer drugs.
• trying to maintain sinus rhythm (ie normal rhythm) and avoiding atrial fibrillation, with antiarrhythmic drugs or ablation procedures.

Although antiarrhythmic drugs help certain patients, they have reduced long-term effectiveness, are not a radical treatment, and may have serious side effects. On the contrary, ablation operations in a percentage of up to 80% achieve the isolation of the short circuits that trigger and maintain the arrhythmia attacks. In this way the patient can get rid of the antiarrhythmic drugs. First of all, the selection of suitable patients is of great importance for the success of the operation. The efficiency of catalysis increases to:

1. paroxysmal atrial fibrillation, when i.e. it occurs in attacks, between which a normal rhythm intervenes.

2. structurally normal heart.

3. younger ages.

However, the literature data of the last two years suggest that even in persistent and chronic atrial fibrillation, despite the relatively reduced effectiveness of ablation, it is superior to medication, as it interferes with multiple mechanisms of arrhythmia production and maintenance. For this reason, international cardiology societies recommend ablation as a first-line treatment (even before drugs are tried) and indeed at an early stage, before the long-term consequences of atrial fibrillation appear on the heart, given that with the development of technology and the significant experience is a safe method with minimal significant complications.

The catalysis techniques that are widely used today are three:

1. H radiofrequency ablationis the classic method, which is constantly being improved with the use of new technology catheters.

2. H cryoballoon ablationhas been widely applied in the last 10 years, as while it is not inferior in effectiveness to the previous method, it is simpler, takes less time and presents a lower probability of complications.

3. Catalysis with pulsed field ablation (PFA). With this technique, short-term electrical pulses are administered whose action is selectively limited to the cells of the heart responsible for atrial fibrillation, but without affecting the adjacent tissues, essentially eliminating the risk of complications from the esophagus (cardioesophageal fistula), the pulmonary veins (stenosis) and the phrenic nerve (paresis).

During one year of implementation of the new method at HYGEIA, 80 operations have been successfully performed, without significant complications. This is helped by the use of ultrasound to puncture the femoral vein, the intraoperative use of esophageal ultrasound and general anesthesia which makes the operation perfectly tolerated by the patient, with an average duration of 1.5 hours. The stay in the Hospital for monitoring is one night and the return to normal activities is in 3-4 days.

Ultimately, the choice of ablation method is individualized and is a function of the experience of the Cardiologist – Electrophysiologist and the individual characteristics of the arrhythmia in each specific patient.

The new advanced treatment of atrial fibrillation using pulsed field energy (Pulsed Field Ablation, PFA) is a technique that provides new possibilities and perspectives.