Safety and efficacy of pulsed field ablation versus cryoablation for atrial fibrillation: A comprehensive meta-analysis.

BACKGROUND

Atrial fibrillation (AF) remains the most common sustained cardiac arrhythmia. Pulsed field ablation (PFA) and cryoablation (CA) aim to isolate pulmonary veins and prevent AF recurrence. This meta-analysis aims to provide a comprehensive comparison of PFA and CA in treatment of AF in context of efficacy, procedural characteristics, and safety profiles.

METHODS

A comprehensive literature search of databases (PubMed, Cochrane Library, Science Direct and Google Scholar) was conducted from their inception to September 2024. Statistical analyses were conducted using Cochrane's RevMan 5.4 software.

RESULTS

Twenty studies (n = 4638; PFA = 2172, CA = 3033) were included in this meta-analysis. Regarding efficacy outcomes, PFA significantly reduced AF recurrence (odds ratio [OR] = 0.68 [0.50-0.94], P = .02) and improved 1-year freedom from atrial arrhythmia (OR = 1.65 [1.18-2.31], P = .004) compared to CA. Procedurally, it demonstrated shorter procedure duration (mean difference [MD] = -11.07 [-14.57 to -7.56], P < .00001), lower contrast dye use (MD = -51.62 [-66.35 to -36.88], P < .00001), and smaller fluoroscopy dose (MD = -5.28 [-9.32 to -1.24], P = .01), though it required more applications (MD = 20.73 [4.98-36.48], P = .01), longer fluoroscopy time (MD = 1.55 [0.68-2.42], P = .0005), and higher post-pulmonary vein isolation high sensitivity cardiac troponin T levels (MD = 570.40 [410.94-729.86], P < .00001). Regarding safety, PFA was associated with a lower overall complication rate (OR = 0.46 [0.32-0.66], P < .0001) and reduced risk of persistent (OR = 0.13 [0.04-0.42], P = .0008) and transient (OR = 0.12 [0.05-0.30], P < .00001) phrenic nerve palsy, but a higher incidence of cardiac tamponade (OR = 2.86 [1.26-6.48], P = .01) and atrial tachycardia (OR = 2.62 [1.41-4.87], P = .002). It also showed superior postoperative heart rate improvement (MD = -8.76 [-15.12 to -2.40], P = .007).

CONCLUSION

PFA offers superior efficacy and some procedural advantages over CA in AF treatment, though with increased risk of certain complications.