Pentaspline Pulsed Field Ablation Versus High‐Power Short‐Duration/Very High‐Power Short‐Duration Radiofrequency Ablation in Atrial Fibrillation: A Meta‐Analysis

Background Pulsed field energy has been proposed as alternative to radiofrequency energy in atrial fibrillation (AF) ablation. Objective To compare data from studies assessing AF ablation with pulsed field ablation (PFA) versus high‐power short‐duration (HPSD) or very HPSD (vHPSD) radiofrequency ablation (RFA) in terms of AF recurrence, procedure‐related complications, fluoroscopy and procedure times. Methods A search of online scientific libraries (from inception to October 1, 2024) was performed. Six studies were considered eligible for the meta‐analysis totaling 1190 patients of whom 568 receiving PFA and 622 receiving HPHD/vHPSD RFA. Results In patients with paroxysmal AF (PAF), a nonsignificant reduction of AF recurrence was related to PFA as compared to HPSD/vHPSD RFA (OR 0.74 [0.50; 1.11], p = 0.14, I 2 10%). In patients with persistent AF (PeAF) a nonsignificant reduction of AF recurrence was related to PFA as compared to HPSD/vHPSD RFA (OR of 0.68 [95%CI 0.35; 1.34], p ‐value 0.27, I 2 10%). In the overall population PFA was associated with a significant reduction of AF recurrence at follow‐up (OR 0.65 [0.47; 0.90], p = 0.009, I 2 11%). No statistical differences were found among the groups in terms of total complications (OR 0.92, [0.45; 1.86], p = 0.81, I 2 = 27%), stroke ( p = 0.78), and cardiac tamponade ( p = 0.80). PFA was associated with significantly longer fluoroscopy time (WMD 8.69 [5.64; 11.75], p < 0.001, I 2 = 95%), but shorter procedure time (WMD −35.16 [ − 46.03; −24.28], p < 0.001, I 2 = 89%) compared to HPSD/vHPSD RFA. Conclusion PFA in AF patients is associated with similar efficacy and safety profiles as compared to HPSD/vHPSD RFA.