JACC. Asia · 2024
Effectiveness and Safety of Pulsed Field Ablation in Patients With Atrial Fibrillation.
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Li Runkai, Zhang Xuefang, Liu Xiao, Gu Zhenbang, He Jiangui, Dong Yugang, Chen Yili, Lip Gregory Y H, Liu Chen, Zhu Wengen
Аннотация
BACKGROUND: As a competitive nonthermal energy technique used in atrial fibrillation (AF), the effectiveness and safety of pulsed field ablation (PFA) has remained uncertain.
OBJECTIVES: The authors meta-analysis aimed to investigate the effectiveness and safety of PFA in treating AF patients and compare its outcomes with conventional thermal ablation.
METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched until January 2024 for relevant studies investigating the use of PFA for AF. A fixed-effects model was used for pooled analysis if the I2 value was <50%; otherwise, a random-effects model was applied.
RESULTS: A total of 46 studies were included in this analysis. The single-arm meta-analysis of 40 studies showed an acute pulmonary vein isolation (PVI) rate of 99.79% per pulmonary vein (PV) and 99.47% per patient, with atrial arrhythmia recurrence rates of 12.36%, 12.42%, and 23.28% at 3, 6, and 12 months, respectively. The safety outcomes incidence was low. In the comparison of 21 studies between PFA and thermal ablation, PFA demonstrated comparable acute PVI rates but a higher first-pass isolation rate. PFA was associated with a lower incidence of atrial arrhythmia recurrence after 3 months and phrenic nerve paralysis or injury, but a higher risk of cardiac perforation or tamponade. Procedure time was shorter with PFA.
CONCLUSIONS: PFA showed noninferiority to thermal ablation in acute PVI and superiority in first-pass isolation, atrial arrhythmia recurrence, phrenic nerve paralysis or injury, and procedure time. However, PFA treatment exhibited a higher risk of cardiac perforation or tamponade.
OBJECTIVES: The authors meta-analysis aimed to investigate the effectiveness and safety of PFA in treating AF patients and compare its outcomes with conventional thermal ablation.
METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched until January 2024 for relevant studies investigating the use of PFA for AF. A fixed-effects model was used for pooled analysis if the I2 value was <50%; otherwise, a random-effects model was applied.
RESULTS: A total of 46 studies were included in this analysis. The single-arm meta-analysis of 40 studies showed an acute pulmonary vein isolation (PVI) rate of 99.79% per pulmonary vein (PV) and 99.47% per patient, with atrial arrhythmia recurrence rates of 12.36%, 12.42%, and 23.28% at 3, 6, and 12 months, respectively. The safety outcomes incidence was low. In the comparison of 21 studies between PFA and thermal ablation, PFA demonstrated comparable acute PVI rates but a higher first-pass isolation rate. PFA was associated with a lower incidence of atrial arrhythmia recurrence after 3 months and phrenic nerve paralysis or injury, but a higher risk of cardiac perforation or tamponade. Procedure time was shorter with PFA.
CONCLUSIONS: PFA showed noninferiority to thermal ablation in acute PVI and superiority in first-pass isolation, atrial arrhythmia recurrence, phrenic nerve paralysis or injury, and procedure time. However, PFA treatment exhibited a higher risk of cardiac perforation or tamponade.