The main complication findings
Major complications occurred in 3.3% of patients who underwent percutaneous pulsed electric field ablation for hepatocellular carcinoma in high-risk anatomical locations, a retrospective review found. The figure represents 10 of 304 patients treated at seven medical centers between July 2015 and July 2025.
Across all reported complications, 23 of 304 patients were affected, an overall rate of 7.6%. The major events primarily involved perioperative systemic events, thoracic injuries in patients with subphrenic tumors and complications along the needle tract.
The study also reported post-ablation syndrome in 18.8% of patients.
How the comparison was made
The researchers examined two forms of pulsed electric field treatment: microsecond pulsed electric field ablation, abbreviated μsPEF, and nanosecond pulsed electric field ablation, or nsPEF. Complications were classified as minor or major using a modified CIRSE classification system.
To compare safety profiles between the two treatment cohorts, the researchers used propensity score matching. They also assessed exploratory oncologic outcomes among patients who had follow-up data available.
The included sample comprised 304 patients with 338 tumors. The patients had a mean age of 58.0 years with a reported plus-or-minus term of 11.0 years, and 241 patients were male.
The study's central aim was to measure the incidence of complications after percutaneous pulsed electric field ablation in this high-risk group and identify factors associated with major complications.
A platelet finding, but no clear winner
Lower platelet count was identified as a significant risk factor for major complications, with a reported p-value of 0.007. Because the data came from a retrospective cohort, the finding describes an association in the observed patients and does not establish that platelet count caused the complications.
After propensity score matching, major complications occurred in 1.9% of patients in the μsPEF cohort and 4.7% of those in the nsPEF cohort. The reported p-value was 0.450, so the study found no statistically significant difference between the groups.
The comparison therefore does not establish that either pulse duration is superior. The matching analysis was used to compare safety profiles, while the supplied findings support similar safety profiles for μsPEF and nsPEF rather than a demonstrated advantage for one.
What the results mean
The authors describe percutaneous pulsed electric field ablation as having a favorable safety profile for hepatocellular carcinoma in high-risk anatomical locations. They emphasize vigilant perioperative care and surveillance of the needle tract, reflecting the types of major events recorded in the cohort.
The findings show how often complications were recorded in this particular patient group and identify lower platelet count as a risk-factor association. They do not prove that pulsed electric field ablation causes fewer complications or is safer than another ablation technique, and they do not establish long-term treatment effectiveness from the information supplied.
The peer-reviewed article was accepted on 20 July 2026 and published as the version of record on 21 August 2026.
Paper data and sources
Original title: Incidence and risk factors of complications following microsecond and nanosecond pulsed electric field ablation for hepatocellular carcinoma: a 10-year multicenter cohort study.
Authors: Danxia Xu, Mengmeng Li, Min Huang et al.
Journal/Repository: European radiology
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s00330-026-12826-8
Original paper · Full text