Efficacy and safety of pulsed field ablation and very high-power short-duration ablation for atrial fibrillation: a meta-analysis

Background Pulsed field ablation (PFA) and very high power short duration ablation (vHPSD) are new techniques for catheter ablation of atrial fibrillation that have been rapidly developed in recent years. However, there are still limited high-quality studies on the clinical efficacy and safety of the two methods in the treatment of atrial fibrillation. Methods We searched PubMed, Embase, Wanfang, CNKI and other Chinese and English databases to collect relevant studies on the efficacy and safety of PFA vs. vHPSD in the treatment of AF published up to May 11, 2026. Two researchers independently completed literature screening and data extraction. We used the Newcastle-Ottawa Scale (NOS) and ROBINS-I tool to evaluate the study quality and risk of bias, respectively. Pooled effect sizes were calculated using random-effects models, and meta-regression and sensitivity analyses were conducted to explore heterogeneity and publication bias. Results A total of 11 observational studies involving 1,476 patients were included. Meta-analysis showed that there was no significant difference in the recurrence rate of atrial fibrillation between the PFA group and the vHPSD group during the follow-up period ( RR = 0.99, 95%CI: 0.91 to 1.07, P = 0.722). There was no significant difference in the rate of pulmonary vein isolation between the two groups ( RR = 1.00, 95%CI: 1.00 to 1.00, P = 1.000). In terms of safety outcomes, there was no significant difference in the total incidence of surgery-related complications between the two groups ( RR = 0.89, 95%CI: 0.58 to 1.35, P = 0.5353). In the continuous outcomes, there were significant differences in procedure time ( MD = −31.64, 95%CI: −40.22 to −23.06, P < 0.0001) and fluoroscopy time ( MD = 6.93, 95%CI: 4.32–9.55, P < 0.0001) between the PFA group and the vHPSD group. Conclusions Based on the existing research evidence, this study indicates that there is no significant difference in the efficacy and safety of catheter ablation for atrial fibrillation between pulsed field ablation (PFA) and very high power short duration ablation (vHPSD). The procedure time of the PFA group is shorter than that of the vHPSD group, and the fluoroscopy time is longer than that of the vHPSD group. In view of the small sample size and short follow-up time, more randomized controlled trials with large sample size and long-term follow-up are still needed to further verify the above conclusions. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261322321 , PROSPERO (Registration ID: CRD420261322321).