Key result
Pulsed field ablation shows no benefit over traditional thermal ablation for preventing atrial arrhythmia recurrence.
Why the study?
The study was conducted to evaluate the efficacy and safety of pulsed field ablation and compare it with traditional thermal ablation in patients with AF.
Does pulsed field ablation improve freedom from atrial arrhythmia recurrence or reduce periprocedural complications compared to traditional thermal ablation in patients with atrial fibrillation?
Meta-Analysis (n=6,229)
Does pulsed field ablation improve freedom from atrial arrhythmia recurrence or reduce periprocedural complications compared to traditional thermal ablation in patients with atrial fibrillation?
Effect estimate: OR 1.24 (95% CI 0.90-1.72)
Pulsed field ablation demonstrates comparable efficacy and safety to traditional thermal ablation for the treatment of atrial fibrillation.
Supports PFA as a comparable alternative for AF ablation; reinforces equivalence versus thermal ablation in mixed randomized and observational data.
Background: The purpose of this meta-analysis was to evaluate the efficacy and safety of pulsed field ablation (PFA) and to compare it with the efficacy and safety of traditional thermal ablation in patients with atrial fibrillation (AF). Methods: PubMed, Web of Science, and Embase were searched for randomized or observational studies exploring the efficacy and safety of PFA and comparing PFA with traditional thermal ablation in patients with AF. Results: A total of 4437 patients from 16 studies that only included PFA as the ablation method and 1792 patients from 9 comparing PFA to traditional thermal ablation were included in the final analysis. In studies that considered PFA alone, the freedom from atrial arrhythmia recurrence was 0.80 (95% confidence interval [CI] 0.76-0.84), and the incidence of periprocedural complications was 0.03 (95% CI 0.02-0.05). In comparative studies, there was no significant difference in the freedom from atrial arrhythmia recurrence (odds ratio (OR) 1.24, 95% CI 0.90-1.72) and the incidence of periprocedural complications (OR 0.74, 95% CI 0.37-1.48) of PFA compared to that of traditional thermal ablation. In the subgroup with a follow-up period less than 12 months, PFA had higher freedom from atrial arrhythmia recurrence rate compared to thermal ablation (OR 2.19, 95% CI 1.14-4.20). Conclusions: PFA is a safe and effective catheter ablation method that is not inferior to the traditional and well-established thermal ablation. It can be used as a treatment of choice for patients with AF. The PROSPERO registration: CRD42023473026, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026.
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Gong et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=6,229). Pulsed field ablation (PFA) vs. Traditional thermal ablation was evaluated on Freedom from atrial arrhythmia recurrence (OR 1.24, 95% CI 0.90-1.72). Pulsed field ablation showed no significant difference in freedom from atrial arrhythmia recurrence compared to traditional thermal ablation (OR 1.24; 95% CI 0.90-1.72).
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