Pulsed-field ablation achieves more durable electrical isolation compared to cryoballoon and radiofrequency pulmonary vein isolation ablation for atrial fibrillation in a meta-analysis of 12 studies

Abstract Background Pulsed field ablation (PFA) is a novel ablation modality for performing pulmonary vein isolation (PVI) in the treatment of atrial fibrillation (AF). The current literature has not reached a consensus on PFA’s superiority over Cryoballoon ablation (CBA) and Radiofrequency ablation (RFA) including High Power Short Duration technology (HPSD). Aim To determine whether PFA is associated with more durably isolated pulmonary veins at repeat PVI procedures compared to CBA and RFA (including HPSD) following PVI ablation for AF. Methods A systematic review with a meta-analysis of studies that compared PFA to CBA or RFA (including HPSD), or PFA to both, was conducted. The Medline, PubMed, and Cochrane libraries were utilised. Patients with paroxysmal and persistent AF were included. We compared the proportion of pulmonary veins that were durably isolated in patients who underwent a repeat ablation ("redo"). Results The PFA group revealed a higher rate of pulmonary vein isolation durability in comparison to the CBA group (RR: 1.04; 95% CI: 0.96 – 1.13, P = 0.36) (Figure 5.1.1). Notably, PFA demonstrated a significantly higher rate of pulmonary vein isolation durability when compared to the RFA (All) group (RR: 1.13; 95% CI: 1.03 – 1.23, P = 0.01) (Figure 5.1.2) and the RFA (non-HPSD group) (RR: 1.16; 95% CI: 1.01 – 1.32, P = 0.03) (Figure 5.1.4). Conclusion(s) Pulmonary vein isolation using pulsed-field ablation is associated with significantly more durable pulmonary vein isolation compared to thermal ablation modalities (CBA and RFA including HPSD).Forrest Plot comparing PV durability