Chair Julian Chun (Frankfurt, DE) led a session on optimising safety in pulsed field ablation (PFA) technology, featuring presenter Vivek Reddy (New York, US) and panellists Arian Sultan (Cologne, DE) and Roland Tilz (Lübeck, DE). Vivek Reddy discussed safety data from the MANIFEST-17K registry, highlighting complication rates and risks associated with PFA, including vascular issues, tamponade and rare cases of coronary spasm and haemolysis-related renal failure. He examined different types of spasm, particularly proximity-related effects and strategies for mitigating risk, such as prophylactic nitroglycerin administration. The discussion also addressed concerns over long-term coronary effects, including potential neointimal hyperplasia.

The panel explored the implications of using PFA versus radiofrequency ablation (RFA), debating whether focal or single-shot devices might be safer in proximity to coronary arteries. Concerns were raised about excessive ablation due to PFA’s ease of use, with Vivek Reddy cautioning against unnecessary lesion delivery. Roland Tilz presented findings on oesophageal temperature rises with PFA, concluding they were not clinically significant. The session concluded with a discussion on PFA’s future applications in ventricular tachycardia (VT) ablation, balancing efficacy with safety, particularly regarding coronary and phrenic nerve proximity.