Key result
Pulsed-field ablation cuts AF procedure time by ~55 minutes vs thermal ablation with similar recurrence and complications.
Why the study?
Although several studies have reported the efficacy and safety of pulsed-field ablation for atrial fibrillation, results from randomised controlled trials were limited.
Does pulsed-field ablation improve clinical outcomes or procedural metrics in patients with atrial fibrillation compared to conventional thermal ablation?
Meta-Analysis (n=906)
Does pulsed-field ablation improve clinical outcomes or procedural metrics in patients with atrial fibrillation compared to conventional thermal ablation?
Pulsed-field ablation for atrial fibrillation significantly reduces procedure time compared to conventional thermal ablation, while maintaining comparable safety and efficacy.
Answers are grounded in this paper and cite their sources.
Enables more efficient atrial fibrillation ablation workflows; confirms comparable safety and efficacy across randomized trials.
Background Pulsed-field ablation is a novel ablation technique using non-thermal energy. Although several studies have reported the efficacy and safety of pulsed-field ablation for atrial fibrillation, results from randomised controlled trials (RCTs) are limited. Purpose The aim of this study was to compare pulsed-field ablation with conventional thermal ablation in patients with atrial fibrillation. Methods We conducted a meta-analysis of RCTs. PubMed, the Cochrane Central Register of Controlled Trials, the web of science, and ClinicalTrials.gov were searched through February 2025 for the terms "radiofrequency OR cryoballoon OR hotballoon OR laser balloon," "pulsed field," "ablation," and "atrial fibrillation." The same terms or related studies were also searched in relevant reviews. The clinical endpoint of this study was recurrence of atrial arrhythmia, complications, total procedure time, and fluoroscopy time. Pooled estimates were calculated using a random-effects model. A two-sided p value < 0.05 was considered statistically significant. RevMan 5.4.1 was used for analysis. Results A total of 906 patients in 4 RCTs were included in this study. Pulsed-field ablation significantly reduced total procedure time compared with conventional thermal ablation (mean difference (MD) -55.04 min.; 95% confidence interval (CI) [-92.74, -17.35]; p = 0.004). On the other hand, fluoroscopy time (MD 3.51 min.; 95% CI [-2.07, 9.08]; p = 0.22) recurrence of atrial arrhythmia (odds ratio (OR) 0.51; 95% CI [0.17, 1.51]; p = 0.23), and occurrence of complications (OR 0.80; 95% CI [0.32, 2.05]; p = 0.65) were similar between the 2 groups. Conclusion In patients with atrial fibrillation, pulsed-field ablation may be associated with reduction in total procedure time, but not fluoroscopy time, recurrent atrial arrhythmia, or complications as compared with conventional thermal ablation. Further large-scale RCTs are warranted to validate the efficacy and safety of pulsed-field ablation.
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R Sakurai (2025) conducted a meta-analysis in atrial fibrillation (n=906). Pulsed-field ablation vs. conventional thermal ablation was evaluated on total procedure time (MD -55.04, 95% CI -92.74, -17.35, p=0.004). Pulsed-field ablation reduced total procedure time but had similar recurrence of atrial arrhythmia compared to conventional thermal ablation.
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