Who is a good candidate for PFA, and who should avoid it?

Ideal candidates include patients with symptomatic paroxysmal or persistent atrial fibrillation (AFib) who have failed or cannot tolerate antiarrhythmic drugs. PFA is particularly suited for those at higher risk of esophageal injury (e.g., prior ablation, thin left atrial wall) due to its tissue selectivity. Contraindications include active infection, intracardiac thrombus, severe valvular disease, or pregnancy. Patients with pacemakers or ICDs require careful device interrogation, as PFA pulses may interfere with sensing.