Key result
Pulsed field ablation systems had low complication rates (0.4-2.0%), with shortest procedural time for FARAPULSE (68.2 mins) and fluoroscopy time for VARIPULSE (7.7 mins).
Why the study?
Pulsed field ablation is an emerging non-thermal technology for AF ablation, but comparative evidence across commercially available PFA systems remained limited.
Does one commercially available pulsed field ablation system improve procedural efficiency and safety compared to others in patients with atrial fibrillation undergoing pulmonary vein isolation?
Meta-Analysis (n=45,563)
Does one commercially available pulsed field ablation system improve procedural efficiency and safety compared to others in patients with atrial fibrillation undergoing pulmonary vein isolation?
All four commercially available pulsed field ablation systems demonstrated high safety and procedural efficiency for atrial fibrillation ablation, with FARAPULSE showing the shortest procedural times and VARIPULSE showing the shortest fluoroscopy times.
All PFA systems demonstrate high safety for AF ablation; network meta-analysis extends comparative evidence ranking FARAPULSE and VARIPULSE highest for efficiency.
Background Pulsed field ablation (PFA) is an emerging non-thermal technology for atrial fibrillation (AF) ablation with promising advantages in tissue selectivity, procedural efficiency, and safety. However, comparative evidence across commercially available PFA systems remains limited. Purpose We aimed to systematically synthesise and compare the baseline characteristics, procedural efficiency, and safety of PFA systems (FARAPULSETM, PulseSelectTM, VARIPULSETM, VoltTM) used for pulmonary vein isolation (PVI) in AF. Methods A comprehensive systematic review of PubMed, Embase, Scopus, and Cochrane was conducted up to 17 October 2025. Studies of AF patients undergoing PVI with commercially available PFA systems (FARAPULSETM, PulseSelectTM, VARIPULSETM, VoltTM) that reported PFA-stratified procedural and safety outcomes were included. Random-effects meta-analyses and network meta-analyses were performed. Results A total of 97 studies involving 45563 patients were included, with majority being observational cohorts (69.1%, n = 67), and involved FARAPULSETM (85.6%, n = 83). Total complication rates were low across all PFA systems (0.4 – 2.0%); pooled procedural time was shortest with FARAPULSETM (68.2 mins, 95% CI 62.8 – 73.5), while fluoroscopy time was shortest with VARIPULSETM (7.7 mins, 95% CI 1.9 – 13.6). On network meta-analysis of studies with multiple PFA systems (n = 15), FARAPULSETM ranked best for procedural time and complication rates, while VARIPULSETM ranked best for fluoroscopy time. Conclusion All four PFA systems studied demonstrated high levels of safety and procedural efficiency for atrial fibrillation ablation. FARAPULSE™ currently possessed the most mature evidence base and reported the shortest procedural times in real-world registries, while VARIPULSE™ showed potential for significantly lower fluoroscopy exposure. Ultimately, the choice of system may depend on specific procedural goals, and the clinical landscape will continue to evolve with emerging evidence and longer-term follow-up for newer platforms.
No takes yet. Share an insight, caveat, or question.
Leow et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=45,563). Pulsed field ablation systems (FARAPULSE, PulseSelect, VARIPULSE, Volt) vs. Head-to-head and network comparison across commercially available PFA systems was evaluated on Procedural efficiency (procedural time and fluoroscopy time) and total complication rates. Pulsed field ablation systems had low complication rates (0.4-2.0%), with shortest procedural time for FARAPULSE (68.2 mins) and fluoroscopy time for VARIPULSE (7.7 mins).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: