Since catheter ablation for atrial fibrillation (AFib) has become a Class 1 indication as first-line therapy in selected patients, pulsed-field ablation (PFA) has emerged as a leading treatment for AFib, with less risk of damage to adjacent anatomy than thermal ablation techniques.

“At Duke, we are early adopters of PFA technologies, which enables us to select the treatment best tailored to the patient, whether that’s medication, PFA, radiofrequency, or a combination,” says Kevin P. Jackson, MD, director of the Duke University Hospital Electrophysiology Lab. “We have a very comprehensive approach toward managing patients with arrhythmias, from lifestyle management to heart rate control.”

The latest research data and analysis using artificial intelligence (AI) continue to advance the technique.

Data suggest PFA’s effect may be substantially more durable than that of thermal ablation. “Data from Europe indicate that 80% or more of patients see long-term AFib prevention after PFA out to three years, and we anticipate that to continue,” says Jackson. “We’re actively enrolling in a study to follow outcomes in newer PFA technologies.”

In the NOGGIN AF study, Jonathan P. Piccini Sr., MD, MHSc, director of the Duke Cardiac Electrophysiology section, examines how to preserve the brain’s natural function and cognition in patients with AFib, comparing the effects of ablation versus medical therapy for rhythm control. Piccini is also an investigator in the AVANT GUARD randomized controlled trial that compares PFA with medical therapy as a first-line treatment for persistent AFib.

Research utilizing AI aims to determine the optimal ablation sites to target in persistent AFib. “It’s exciting to use AI to look for patterns in the chaos and predict an individual’s triggers,” says Duke cardiologist Zak Loring, MD, MHS, associate director of the Arrhythmia Core Lab at Duke Clinical Research Institute.

The TAILORED-AF trial used AI in real time to identify areas of spatiotemporal dispersion in heart tissues that sustain arrhythmias, allowing physicians to target these areas during ablation. In an April 2025 article in Nature, Loring and Piccini evaluated the study’s findings, noting that the technique did seem to reduce AFib recurrence, although further research is needed. They also found that other non-AFib arrhythmias increased.

“We’re on the right track, but we haven’t fully answered the question,” Loring says. He adds that Duke is participating in pilot studies of AI-guided ablation technologies as a supplement to the standard of care, and Duke’s expertise and experience in AFib are world class. “There’s no better place to send a patient than Duke,” he concludes.

Jackson agrees, noting that early referral is important. “The earlier we can address AFib, the better the patient outcomes.”