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.