Abstract 4360259: Meta-analysis of outcomes with pulsed-field ablation vs. cryoablation in atrial fibrillation patients

Background: Pulsed-field ablation (PFA) is a nonthermal ablation method for pulmonary-vein isolation to treat atrial fibrillation. Limited data is available to compare PFA with cryoballoon ablation (CBA). Methods: We searched PubMed, Cochrane, and Embase for studies comparing PFA and CBA with at least one outcome of interest. Data analysis was performed using Cochrane RevMan 5.4. Dichotomous variables were compared using the Mantel-Haenszel method in a random-effects model to calculate the risk ratio and 95% confidence intervals (CI). Continuous variables were compared using the inverse variance method in a random-effects model to calculate standard mean differences (SMD) and 95% CI. Results: 16 studies and 2,090 patients (1,141 in the PFA group and 949 in the CBA group) were included. 9 studies reported AF recurrence after the blanking period of 3 months with a lower pooled risk seen in PFA than CBA group (RR 0.80; 95% CI 0.68, 0.95). 11 studies reported periprocedural complications rate without any significant difference in pooled risk between PFA and CBA (RR 0.74; 95% CI 0.44, 1.26). 13 studies reported procedural time, which was lower with PFA than CBA (SMD -0.43; 95% CI -0.83, -0.04). However, fluoroscopy time was higher with PFA than CBA (SMD 0.29; 95% CI 0.06, 0.52) (11 studies). Three studies reported an increase in high-sensitivity troponin, with higher levels after CBA compared to PFA (SMD 2.05; 95% CI 0.50, 3.61). A higher decrease in heart rate was observed in the PFA group post-procedure (SMD -0.97; 95% CI -1.73 to -0.21) (4 studies). Conclusion: The use of PFA is associated with lower AF recurrence rates, shorter procedure durations, and a more significant decrease in heart rate compared to CBA. The fluoroscopy times are higher with PFA, and periprocedural complication rates are similar to those with CBA.