Key result
Same-day discharge PFA shows similar 30-day major adverse events compared with thermal ablation.
Why the study?
Established same-day discharge protocols after AF ablation are largely based on thermal energy sources, and large-scale comparative data evaluating pulsed-field ablation against thermal ablation within same-day discharge programmes remain limited.
Does pulsed-field ablation improve safety (reduce composite major adverse events within 30 days) compared to thermal ablation in patients undergoing atrial fibrillation ablation with same-day discharge?
Meta-Analysis (n=1,011)
Does pulsed-field ablation improve safety (reduce composite major adverse events within 30 days) compared to thermal ablation in patients undergoing atrial fibrillation ablation with same-day discharge?
Same-day discharge following pulsed-field ablation for atrial fibrillation demonstrates a 30-day safety profile comparable to thermal ablation, with no significant differences in major adverse events, mortality, or readmissions.
Supports same-day discharge after pulsed-field ablation; extends thermal ablation safety data to this modality.
Background Same-day discharge (SDD) after atrial fibrillation (AF) ablation is increasingly adopted to optimise healthcare resource utilisation without compromising safety. While established SDD protocols are largely based on thermal energy sources, pulsed-field ablation (PFA) may further streamline workflows due to shorter procedure times and a favourable safety profile. However, large-scale comparative data on energy modalities within SDD programmes remain limited. Purpose To perform a meta-analysis comparing the safety of PFA versus thermal ablation for AF ablation within established SDD protocols. Methods A systematic search of PubMed, Embase, and Cochrane databases was conducted to identify randomised controlled trials or observational studies comparing PFA with radiofrequency/cryoballon in SDD patients who underwent AF ablation. The primary endpoint was a composite of major adverse events within 30 days. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model with the Hartung-Knapp-Sidik-Jonkman method. Results Three studies, including 1011 patients (402 PFA, 609 thermal), were included. In the PFA group, 77.5% of procedures were performed with the pentaspline catheter. In the thermal group, radiofrequency was performed in 43% of cases. SDD after PFA was not linked to an increased rate of major adverse events (RR 3.32; 95% CI: 0.63 – 17.55; I² = 0%) or all-cause mortality (RR 1.40; 95% CI: 0.15 – 13.40; I² = 0%) within 30 days compared to thermal ablation (Figure 1). The 30-day all-cause readmission rate showed no significant difference (RR 2.32; 95% CI: 0.44 – 12.30; I² = 51%) (Figure 2). Conclusion In patients undergoing PFA, SDD demonstrated a safety profile comparable to that observed after thermal ablation for AF and may further enhance procedural workflow efficiency. However, randomized controlled trials are required to confirm these findings and establish definitive conclusions.
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Bistriceanu et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=1,011). Pulsed-field ablation (PFA) with same-day discharge vs. Thermal ablation (radiofrequency or cryoballoon) with same-day discharge was evaluated on Composite of major adverse events within 30 days (RR 3.32, 95% CI 0.63-17.55). Pulsed-field ablation with same-day discharge did not increase 30-day major adverse events compared with thermal ablation (RR 3.32; 95% CI 0.63-17.55).
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