What does this research mean for the field?

Pulsed field ablation significantly reduces atrial tachyarrhythmia recurrence and shortens procedural duration compared with high-power/very high-power short-duration ablation in patients with atrial fibrillation, while maintaining similar complication rates. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 5, 2025Heart Rhythm O2Open Access

Pulsed field ablation vs high-power short duration/very high-power short duration pulmonary vein isolation—Systematic review and meta-analysis with Kaplan-Meier reconstructed individual patient data

Q: What are the key findings of this study?

Pulsed field ablation significantly reduced atrial tachyarrhythmia recurrence compared with high-power/very high-power short-duration ablation (15% vs 25%; OR 0.57) in patients with atrial fibrillation.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation (n=1411). Intervention: Pulsed field ablation vs. High-power/very high-power short-duration ablation. Primary outcome: Atrial tachyarrhythmia recurrence (OR 0.57, 95% CI 0.40-0.81, p=0.002).

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Key result

Pulsed field ablation reduces atrial tachyarrhythmia recurrence ~43% versus high-power short-duration ablation in AF.

OR 0.57
95% CI 0.40-0.81
P=0.002
n=1,411

Why the study?

This study compared the efficacy, procedural duration, and safety of pulsed field ablation versus high-power/very high-power short-duration pulmonary vein isolation.

Does pulsed field ablation reduce atrial tachyarrhythmia recurrence and procedural duration compared to HPSD/VHPSD ablation in patients undergoing pulmonary vein isolation?

Study Design

Type

Meta-Analysis (n=1,411)

Structured PICO

Does pulsed field ablation reduce atrial tachyarrhythmia recurrence and procedural duration compared to HPSD/VHPSD ablation in patients undergoing pulmonary vein isolation?

Population

Patients undergoing pulmonary vein isolation for atrial tachyarrhythmias

Intervention

Pulsed field ablation (PFA)

Comparator

High-power/very high-power short-duration (HPSD/VHPSD) ablation

Outcome

Atrial tachyarrhythmia (ATa) recurrence (any episode of atrial fibrillation, flutter, or tachycardia lasting >30 seconds, detected by Holter monitoring or electrocardiography, after a 3-month blanking period)composite

Main Result

Effect estimate: OR 0.57 (95% CI 0.40-0.81)

Absolute Event Rate: 15% vs 25%

p-value: p=0.002

Pulsed field ablation offers a shorter procedural duration with comparable or potentially better efficacy and similar safety compared to HPSD/VHPSD ablation for pulmonary vein isolation.

Limitations

Absence of randomized controlled trials, with most included studies being retrospective in nature
Follow-up durations were relatively short
Need for more detailed and standardized reporting of prognostic variables, such as left atrial diameter, to enable more robust meta-regression analyses

Implication

Favors pulsed field ablation for atrial fibrillation ablation; extends trial data via meta-analysis of high-power short-duration comparisons.

Abstract

Background: High-power/very high-power short-duration (HPSD/VHPSD) pulmonary vein isolation has greater efficacy than does conventional pulmonary vein isolation, while pulsed field ablation (PFA) is associated with a significantly shorter procedural duration with comparable efficacy. Objective: This meta-analysis compared the efficacy, procedural duration, and safety of PFA vs HPSD/VHPSD ablation. Methods: Atrial tachyarrhythmia (ATa) recurrence was defined as any episode of atrial fibrillation, flutter, or tachycardia lasting >30 seconds, detected by Holter monitoring or electrocardiography, after a 3-month blanking period. The intervention group received PFA and the control group received HPSD/VHPSD ablation. Results: < .001). Complications rates were similar between the 2 groups. Conclusion: PFA was potentially associated with a comparable or reduced ATa recurrence rate and a shorter procedural duration compared with HPSD/VHPSD ablation while maintaining similar complication rates. Further randomized controlled trials are warranted to validate these findings. PROSPERO registration number: CRD420251034443.

Discussion

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Published by Heart Rhythm O2 · CC BY

Cite This Study

Pranata et al. (2025) conducted a meta-analysis in Atrial fibrillation (n=1,411). Pulsed field ablation vs. High-power/very high-power short-duration ablation was evaluated on Atrial tachyarrhythmia recurrence (OR 0.57, 95% CI 0.40-0.81, p=0.002). Pulsed field ablation significantly reduced atrial tachyarrhythmia recurrence compared with high-power/very high-power short-duration ablation (15% vs 25%; OR 0.57) in patients with atrial fibrillation.

synapsesocial.com/papers/6a15bb75b2e0231f1582ea1e https://doi.org/10.1016/j.hroo.2025.06.011

Topics

Atrial fibrillation

Persistent AF management

AF ablation outcomes

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Implication

Favors pulsed field ablation for atrial fibrillation ablation; extends trial data via meta-analysis of high-power short-duration comparisons.

Pulsed field ablation vs high-power short duration/very high-power short duration pulmonary vein isolation—Systematic review and meta-analysis with Kaplan-Meier reconstructed individual patient data

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Pulsed field ablation vs high-power short duration/very high-power short duration pulmonary vein isolation—Systematic review and meta-analysis with Kaplan-Meier reconstructed individual patient data

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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