In the treatment of atrial fibrillation (AF), catheter ablation has developed from a specialized option to the mainstay of a modern rhythm strategy within a decade. In 2025, two developments are shaping the debate: on the one hand, the updated guidelines increasingly anchor ablation as a first-line therapy – for suitable indications – and on the other hand, pulsed-field ablation (PFA) is technically and conceptually challenging the previously dominant thermal procedures – in particular radiofrequency ablation (RF) using the high-power short-duration (HPSD) technique. Randomized studies, registries and safety analyses provide a differentiated picture: PFA is not inferior to conventional thermal ablation in paroxysmal AF, shows procedural advantages and a special safety profile, but brings with it new, characteristic side effects. RF ablation, for its part, has achieved significant efficiency and safety gains with HPSD and optimized workflow standards.
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