Key result
Pulsed field ablation proves noninferior to thermal ablation, achieving ~99% acute PVI.
Why the study?
As a competitive nonthermal energy technique for AF, the effectiveness and safety of pulsed field ablation remained uncertain.
Does pulsed field ablation improve effectiveness and safety compared to conventional thermal ablation in patients with atrial fibrillation?
Meta-Analysis
Does pulsed field ablation improve effectiveness and safety compared to conventional thermal ablation in patients with atrial fibrillation?
Pulsed field ablation is noninferior to thermal ablation for acute PVI and superior for first-pass isolation and arrhythmia recurrence, but carries a higher risk of cardiac perforation or tamponade.
PFA noninferior to thermal ablation for acute PVI and 12-month recurrence; reinforces its role as an alternative in AF ablation.
Background: As a competitive nonthermal energy technique used in atrial fibrillation (AF), the effectiveness and safety of pulsed field ablation (PFA) has remained uncertain. Objectives: The authors meta-analysis aimed to investigate the effectiveness and safety of PFA in treating AF patients and compare its outcomes with conventional thermal ablation. Methods: value was <50%; otherwise, a random-effects model was applied. Results: A total of 46 studies were included in this analysis. The single-arm meta-analysis of 40 studies showed an acute pulmonary vein isolation (PVI) rate of 99.79% per pulmonary vein (PV) and 99.47% per patient, with atrial arrhythmia recurrence rates of 12.36%, 12.42%, and 23.28% at 3, 6, and 12 months, respectively. The safety outcomes incidence was low. In the comparison of 21 studies between PFA and thermal ablation, PFA demonstrated comparable acute PVI rates but a higher first-pass isolation rate. PFA was associated with a lower incidence of atrial arrhythmia recurrence after 3 months and phrenic nerve paralysis or injury, but a higher risk of cardiac perforation or tamponade. Procedure time was shorter with PFA. Conclusions: PFA showed noninferiority to thermal ablation in acute PVI and superiority in first-pass isolation, atrial arrhythmia recurrence, phrenic nerve paralysis or injury, and procedure time. However, PFA treatment exhibited a higher risk of cardiac perforation or tamponade.
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Li et al. (2024) conducted a meta-analysis in Atrial fibrillation. Pulsed field ablation (PFA) vs. Conventional thermal ablation was evaluated on Acute pulmonary vein isolation (PVI) rate per patient. Pulsed field ablation achieved a 99.47% acute pulmonary vein isolation rate per patient and was noninferior to thermal ablation, with a 23.28% atrial arrhythmia recurrence rate at 12 months.
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