Catheter-based pulmonary vein isolation (PVI) is an established and effective treatment for symptomatic atrial fibrillation (AF), demonstrating superiority over antiarrhythmic drug therapy in maintaining sinus rhythm and improving symptoms (1–2).

Despite three decades of progress since the advent of PVI, two principal concerns remain. First, approximately one in three patients experience recurrence of atrial arrhythmias within one year of the procedure (3). Second, current ablation techniques employ radiofrequency or cryothermal energy, which may cause indiscriminate tissue injury to surrounding structures such as the oesophagus and phrenic nerve. Although infrequent, this can result in serious complications – in some cases leading to death (4–7).