Is Pulse Field Ablation a Better Choice Than Cardioversion

Not so much....so far. All they have done is to approve it as yet another way of ablating the endothelium around the pulmonary veins. It's marginally safer, but only for the PVI (pulmonary vein isolation) procedure. One benefit, as I understand it, is that there is no longer the need to do a TEE on the patient concurrent to the ablation procedure, as it is in RF ablation.

I've had AF since 2021 and in my experience, the next step might be electrical cardioversion to more-quickly restore regular rhythm, which is called "normal sinus rhythm" or NSR. And after that, she might get an alblation [along with drug therapy or instead of drugs] to maintain NSR.

There is no proof yet that pulsed field is any better than RFA. In fact Some believe including my EP who is top notch with 35 years in the field connected to a large university based medical center says that pulsed field is only marginally useful in special cases. I posted an editorial about this in a thread here on pulsed field ablation.
" Pulsed Field Ablation for AF: Are US Electrophysiologists Too Easily Impressed?"
https://www.medscape.com/viewarticle/pulsed-field-ablation-af-are-us-electrophysiologists-too-2024a1000d2v?form=fpf
I just had my 2nd RFA in the last 5 1/2 years. My 2nd ablation was needed due to increasing frequency of Afib events at the 4 years mark after my first RAF. But even then the Afib events I have experienced since my first ablation have been much lower in duration and have not need cardiofversions nor do I take any drugs.

I've had four cardioversions. None of them put me in NSR for more than 16 hours, with the average only 4 hours. Cardioversions ARE useful for some people, and that's why they do them. But for many others, they simply are ineffective at correcting PACs or AF.

True - and I am VERY fortunate that cardioversions were successful, for me.

Thank God for small mercies, eh? 😀

Thanks for the comments to my question. When I read about PFA from sources that were from centers of excellence, the one thing that seemed to be repeated was the change in risk, even though I read non PFA ablation has a .5 to 5% risk, which is obviously low. I was concerned about the esophagus and the phrenic nerve which could affect her breathing and PFA data, so far, showed no impact in those areas.

Excellent - you're getting GOOD data! And PFA has another significant advantage, in the left atrium. That's pulmonary vein [PV] stenosis. Older technologies "stiffen" the PV.

The danger from the RF wand is considerable, but it depends on both the skill and experience of the EP performing the procedure AND the location of the re-entrant...the entry point of the unwanted and damnable ...er...sorry....dammable electrical signal. 😀

The typical points that have to be ablated, in order of highest to lowest probability are:

a. pulmonary vein ostia
b. coronary sinus
c. left atrial appendage (yeah, that place again)
c. Vein of Marshal (usually treated with cryo-therapy, meaning they pump icy fluid through it to kill the focus), and
d. the septum....the wall between the two atria.

The pulmonary veins, because of where they enter the left atrium, and the atrial appendage, I believe (not sure) are the two most risky because of the orientation of the typically oriented heart. Those two places are most proximal to the two areas wanting to be spared by having a TEE placed to monitor while the EP is placing the RF and making small lesions that will scar and become impassable to the spurious electrical signal. Blocked signal, contained inside a 'coffer' dam of fibrosis left from the scarred tissue created via RF = no more ectopy...no more extra beats.

I’m a little dismayed that the people on this group appear to assume that ablation is a cure for Afib. It does reduce the occurrence of Afib IN SOME people. So does cardioversion.

I have had 4 ablations.. the 4 th left me with pulmonary hypertension…, Each ablation left me with a new atrial flutter.
I’ve only had one cardioversion and that left me without Afib for about 10 months. The only time I was Afib free for more than a week in the last 20 years.

Cardioversion does no damage to the heart( the current thinking).
Ablation cause scar tissue to achieve the desired effect, but the new techniques only damage the one spot and doesn’t effect surrounding tissue (the current thinking).

However, I have had paroxysmal Afib for 20 years. So, many times I wound up in sinus rhythm before the scheduled cardioversion.

There are some people who go to the emergency room whenever they go into Afib and get a cardioversion.

That being said, the conversation should be had with your EP and a cardiologist, to ensure you get the procedure that is specific to your particular case.
When I first started with Afib, no one could tell me what caused it…. The current knowledge at the time was due to thyroid problems. They are learning more each day.., including learning your triggers.

And learning different types of Afib.
Good Luck with you issues and please speak with your Ep.