Pulsed field ablation was associated with higher freedom from arrhythmia recurrence compared with thermal ablation in patients with atrial fibrillation (HR 0.68; 95% CrI 0.55-0.84).
Meta-Analysis (n=3,120)
Does pulsed field ablation reduce arrhythmia recurrence in patients with atrial fibrillation compared to thermal ablation?
Pulsed field ablation is associated with reduced atrial arrhythmia recurrence and shorter procedural times compared to thermal ablation, though the efficacy benefit is more modest in randomized trials than in observational studies.
Effect estimate: HR 0.68 (95% CI 0.55-0.84)
BACKGROUND Pulsed field ablation (PFA) has emerged as a promising alternative to thermal catheter ablation for pulmonary vein isolation in atrial fibrillation (AF). OBJECTIVES To estimate the efficacy and safety of PFA versus thermal ablation in AF. METHODS We searched PubMed, Embase, and Cochrane through July 2025 for studies comparing PFA with thermal ablation. Individual patient data were reconstructed from Kaplan-Meier curves, and hazard ratios (HR) were estimated using a Cox frailty regression model. Time-to-benefit was assessed to determine when the treatment effect becomes clinically meaningful. Study-level odds ratios (OR) and mean differences with 95% credible intervals (CrI) were estimated with a Bayesian random-effects model and non-informative priors for primary analyses. RESULTS Twelve studies (4 RCTs, 8 observational) involving 3,120 patients (46.6% PFA) were included. Time-to-event analysis (1 RCT, 6 observational) showed PFA was associated with higher freedom from arrhythmia recurrence (HR 0.68; 95% CrI, 0.55-0.84). A time to benefit of 12 months was needed to prevent 5 atrial arrhythmia recurrences per 100 PFA-treated patients. In study-level analyses, the probability of a clinically meaningful reduction (OR < 0.8) in arrhythmia recurrence was 34.1% for RCTs and 96.5% for observational studies. PFA had a high likelihood of shorter procedural and left atrial dwell times. Safety outcomes showed no consistent excess risk with PFA. CONCLUSION In patients with AF undergoing catheter ablation, PFA was associated with reduced arrhythmia recurrence compared with thermal ablation, with larger effects in observational studies and more modest effects in RCTs, and no signal of increased harm.
Queiroga et al. (Sun,) conducted a meta-analysis in Atrial fibrillation (n=3,120). Pulsed field ablation vs. Thermal ablation was evaluated on Freedom from arrhythmia recurrence (HR 0.68, 95% CI 0.55-0.84). Pulsed field ablation was associated with higher freedom from arrhythmia recurrence compared with thermal ablation in patients with atrial fibrillation (HR 0.68; 95% CrI 0.55-0.84).