Key result
Pulsed-field ablation was associated with shorter total procedural time (MD -36.39 min; 95% CI -46.23 to -26.55; p<0.00001) compared to high-power short-duration radiofrequency ablation.
Why the study?
Atrial fibrillation is treated using thermal and nonthermal techniques, but no prior meta-analysis had compared pulsed-field ablation with high-power short-duration radiofrequency ablation.
Does pulsed-field ablation improve procedural efficiency compared to high-power short-duration radiofrequency ablation in patients with atrial fibrillation?
Meta-Analysis (n=1,538)
Does pulsed-field ablation improve procedural efficiency compared to high-power short-duration radiofrequency ablation in patients with atrial fibrillation?
Pulsed-field ablation offers shorter procedural and left atrial dwell times but longer fluoroscopy times compared to high-power short-duration radiofrequency ablation, with comparable safety and efficacy.
Provides the first pooled comparison of pulsed-field versus high-power short-.
Background Atrial fibrillation, which has increased in prevalence by 33% over the past two decades, affects 59 million people worldwide. It is treated using thermal and nonthermal techniques like radiofrequency, cryoballoon, laser, and pulsed‐field ablation (PFA). This meta‐analysis is the first to compare PFA with high‐power short‐duration radiofrequency ablation (HPSD‐RFA). Methods We comprehensively searched PubMed, Cochrane Central, and ScienceDirect from inception to August 2024. In Review Manager 5.4.1, we pooled risk ratios (RRs) and weighted mean difference (WMD) along with 95% confidence intervals for dichotomous and continuous outcomes, respectively, and employed a random effects model. Study quality was assessed via the Newcastle–Ottawa Scale, and funnel plots were used to evaluate the risk of publication bias. Results Seven studies with a total of 1538 patients were analyzed in this meta‐analysis. PFA was associated with a shorter total procedural time (MD = −36.39 min; 95% CI: [−46.23, −26.55]; p < 0.00001; I2 = 90%), left atrial dwell time (MD = −33.22 min; 95% CI: [−53.21, −13.23]; p = 0.001; I2 = 93%), and a longer fluoroscopy time compared to the HPSD‐RFA (MD = 9.06 min; 95% CI: [6.13, 11.99]; p < 0.00001; I2 = 96%). Other outcomes were comparable between the two arms. Conclusion PFA outperforms HPSD ablation in terms of procedural efficiency outcomes except for the total fluoroscopy time. Still, both techniques are comparable regarding safety and arrhythmia control outcomes.
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Abideen et al. (2025) conducted a meta-analysis in Atrial fibrillation (n=1,538). Pulsed-field ablation (PFA) vs. High-power short-duration radiofrequency ablation (HPSD-RFA) was evaluated on Total procedural time (MD -36.39, 95% CI -46.23, -26.55, p=<0.00001). Pulsed-field ablation was associated with shorter total procedural time (MD -36.39 min; 95% CI -46.23 to -26.55; p<0.00001) compared to high-power short-duration radiofrequency ablation.
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