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).

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 O21 citationsOpen 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

RPRaymond PranataElectrophysiology WKWilliam KamarullahDr. Hasan Sadikin General Hospital GKGiky KarwikyElectrophysiology

Key Result

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.

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

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.

Main Result

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

Absolute Event Rate: 15% vs 25%

p-value: p=0.002

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

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.

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