Pulsed field ablation (PFA) is emerging as alternative to thermal ablation for pulmonary vein isolation (PVI) in atrial fibrillation, though PFA-specific complications have arisen. This review provides an overview of efficacy and safety of single-shot PFA systems. Of 804 PubMed studies (January 14, 2026), 47 primary PVI studies were included. All PFA systems reported almost 100% acute PVI. The multispline, circular and spherical catheters showed significant changes in hemolysis biomarkers. However, AKI occurred only with the pentaspline (n=39/1307) and variable loop catheters (n=4/122). Myocardial injury biomarkers significantly increased in the multispline, circular and spherical catheters. Hemolysis, AKI and myocardial injury were all linked to more applications. Six to twelve months arrhythmia-free survival was 55-88% for both the multispline and circular catheters and 77-88% for the spherical catheters. Comparison is difficult due to heterogeneity of systems. Prospective trials are needed to optimize PFA dosing balancing efficacy and safety.