Key result
Pulsed field ablation reduces atrial tachyarrhythmia recurrence by ~17% vs thermal ablation in persistent AF.
Why the study?
Comparative data between pulsed field ablation and thermal ablation for persistent atrial fibrillation remain limited.
Does pulsed field ablation reduce the recurrence of atrial tachyarrhythmias compared to thermal ablation in patients with persistent atrial fibrillation?
Meta-Analysis (n=1,610)
Does pulsed field ablation reduce the recurrence of atrial tachyarrhythmias compared to thermal ablation in patients with persistent atrial fibrillation?
Pulsed field ablation is associated with a lower recurrence of atrial tachyarrhythmias and shorter procedural times compared to thermal ablation in patients with persistent atrial fibrillation.
Supports PFA over TA to reduce atrial tachyarrhythmia recurrence in persistent AF; extends prior trial data via meta-analysis.
Background Pulsed field ablation (PFA) has emerged as an innovative non-thermal approach with significant promise for treating atrial fibrillation (AF). However, comparative data between PFA and thermal ablation (TA, including cryoballoon ablation [CBA] and radiofrequency ablation [RFA]) for persistent AF (PerAF) remain limited. Methods A systematic search was conducted in the Medline, PubMed, Embase, and Cochrane Library databases to include all relevant studies that compared PFA with TA. Results Six trials involving 1610 patients were included in the study. Pooled analyses revealed that PFA exerted significant advantages over TA, characterized by lower recurrence of atrial tachyarrhythmias (ATAs) (risk ratio [RR]: 0.83; 95% confidence interval [CI]: 0.70 to 0.97; P = 0.02), especially for AF recurrence (RR: 0.79; 95% CI: 0.65 to 0.95; P = 0.015). Furthermore, PFA significantly reduced procedural time (standard mean difference [SMD]: −1.25; 95% CI: −1.87 to − 0.64; P < 0.00001) and left atrial dwell (LAD) time (SMD: −14.21; 95% CI: −27.60 to − 0.82; P = 0.04). No significant differences were observed between the two groups regarding fluoroscopy time and complications. Conclusion PFA is effective and safe for PerAF treatment, featuring shorter procedure time, LAD time and lower ATAs recurrence.
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Li et al. (2026) conducted a meta-analysis in Persistent atrial fibrillation (PerAF) (n=1,610). Pulsed field ablation (PFA) vs. Thermal ablation (TA, including cryoballoon ablation and radiofrequency ablation) was evaluated on Recurrence of atrial tachyarrhythmias (ATAs) (RR 0.83, 95% CI 0.70 to 0.97, p=0.02). Pulsed field ablation significantly reduced the recurrence of atrial tachyarrhythmias (RR 0.83) compared to thermal ablation in patients with persistent atrial fibrillation.
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