Meta-analysis of the safety and efficacy between pulsed field ablation vs. traditional ablation for persistent atrial fibrillation.

BACKGROUND

Pulsed field ablation (PFA) has emerged as an innovative non-thermal approach with significant promise for treating atrial fibrillation (AF). We performed a meta-analysis between PFA and traditional ablation (TA, including cryoballoon ablation [CBA] and radiofrequency ablation [RFA]) for persistent atrial fibrillation (PerAF).

METHODS

A systematic search was conducted in the Medline, PubMed, Embase, and Cochrane Library databases to include all relevant studies that compared PFA with TA.

RESULTS

Six trials involving 1,610 patients were included in the study. Pooled analyses revealed that PFA exerted significant advantages over TA, characterized by lower recurrence of atrial tachyarrhythmias (ATAs) (risk ratio [RR]: 0.83; 95% CI: 0.70 to 0.97; P = 0.02). Further analysis revealed no significant difference when PFA was compared with CBA alone (RR: 0.89, 95% CI: 0.74 to 1.08, P = 0.24), whereas PFA was superior to RFA (RR: 0.75, 95% CI: 0.59 to 0.96, P = 0.02). For AF recurrence, PFA also demonstrated a lower rate compared with TA (RR: 0.79, 95% CI: 0.65 to 0.95, P = 0.01), and this advantage was also observed in the comparison with CBA (RR: 0.71, 95% CI: 0.52 to 0.99, P = 0.04). No significant difference was found between PFA and TA in terms of the atrial tachycardia/atrial flutter (AT/AFL). In addition, PFA significantly shortened the procedural time (standard mean difference [SMD]: -1.25, 95% CI: -1.87 to -0.64, P < 0.00001) and left atrial dwell (LAD) time (SMD: -0.51, 95% CI: -0.99 to -0.03, P = 0.04). However, PFA required a longer fluoroscopy time compared with RFA (SMD: 1.67, 95% CI: 1.12 to 2.22, P < 0.00001). There was no significant difference in the incidence of complications between the two groups.

CONCLUSION

PFA is effective and safe for PerAF treatment, featuring shorter procedure time and lower ATAs recurrence.