Safety and efficacy of the pulsed field ablation for persistent atrial fibrillation: a meta-analysis.

BACKGROUND

Pulsed field ablation (PFA) has emerged as an innovative non-thermal approach with significant promise for treating atrial fibrillation (AF). However, comparative data between PFA and thermal ablation (TA, including cryoballoon ablation [CBA] and radiofrequency ablation [RFA]) for persistent AF (PerAF) remain limited.

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 1610 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% confidence interval [CI]: 0.70 to 0.97; P = 0.02), especially for AF recurrence (RR: 0.79; 95% CI: 0.65 to 0.95; P = 0.015). Furthermore, PFA significantly reduced 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: -14.21; 95% CI: -27.60 to - 0.82; P = 0.04). No significant differences were observed between the two groups regarding fluoroscopy time and complications.

CONCLUSION

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