Pulsed-field ablation versus radiofrequency ablation for paroxysmal atrial fibrillation: a systematic review and meta-analysis

Background Pulmonary vein isolation (PVI) is an effective treatment for paroxysmal atrial fibrillation (AF). Pulsed-field ablation (PFA) is a novel nonthermal cardiac tissue-selective energy modality. However, its efficacy and safety compared with radiofrequency ablation (RFA) remain uncertain. Purpose To compare the efficacy and safety of PFA versus RFA for paroxysmal atrial fibrillation. Methods We systematically searched PubMed, Embase, and Cochrane Library databases for studies comparing PFA and RFA in patients with paroxysmal AF. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous outcomes, respectively. All statistical analyses were performed using R software version 4.3.1 with a random-effects model. Results We included one randomized controlled trial (RCT) and five observational studies comprising 1,863 patients with paroxysmal AF, of whom 839 (45%) underwent PFA. The mean age was 64.2 years, and the follow-up duration ranged from 12 to 30 months. As compared with RFA, PFA was associated with a shorter procedural time (MD -39.2 min; 95% CI -58.2 to -20.1; p < 0.01), while no statistical differences were found in terms of cardiac tamponade (RR 0.87; 95% CI 0.26 to 2.87; p = 0.82), success rate (RR 1.06; 95% CI 0.99 to 1.14; p = 0.09), or major complications (RR 1.84; 95% CI 0.61 to 5.50; p = 0.28) between PFA and RFA. Conclusions In this meta-analysis, PFA showed a reduced procedural time, with comparable efficacy and safety profiles.