Ultrasound (US)-assisted electrochemical oxidation (EO) has previously demonstrated its ability to degrade perfluorooctanoic acid (PFOA). However, the mechanisms of direct electron transfer and indirect oxidation by reactive oxygen species (ROS), as well as the involvement of these ROS, are unclear, particularly with the peroxydisulfate (PDS) electrolyte and the added effect of US. In this study, an US/EO/PDS system was first investigated, achieving nearly 100 % and 80.01 % defluorination for PFOA and perfluorooctane sulfonate, respectively (within 3 h). This US/EO/PDS system exhibited remarkable stability, pH tolerance, and practicality. Further experimental and theoretical studies revealed that the predominant mechanism of PFOA defluorination was indirect oxidation via ROS, rather than direct oxidation at the anode. Although none of these ROS could initiate the degradation of PFOA without additional energy, both ROS (SO4∙- > •OH > 1O2 > O2∙-) and US/EO contributed to the initial step of PFOA defluorination. Furthermore, US enhanced the generation of ROS and the direct oxidation (electron transfer) ability of EO. The electrons were transferred from PFOA to PDS via the electrode assembly. This study clarified, for the first time, the synergistic effect of US/EO/PDS and the involvement of direct and indirect ROS oxidation in defluorination of PFOA, which shows potential for developing US and EO technology for complete degradation of polyfluoroalkyl substances.