Pulsed Field Ablation Versus High-Power Short-Duration Ablation in Atrial Fibrillation: A Systematic and Meta-Analysis

To compare the efficacy, safety, and procedural characteristics of pulsed field ablation (PFA) versus high-power short-duration (HPSD) radiofrequency ablation in patients with atrial fibrillation (AF). We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies comparing PFA and HPSD in AF ablation. A comprehensive search was performed in PubMed and relevant databases through July 2025. A total of 12 studies were included, with data extracted on baseline characteristics, procedural details, clinical outcomes, and complications. Risk of bias was assessed using appropriate tools for randomized and nonrandomized studies. Statistical pooling was conducted using random-effects models where feasible. Across 12 studies including over 2000 patients, freedom from AF at 12 months was similar between PFA (mean 85.3%) and HPSD (mean 83.2%). PFA demonstrated a lower incidence of complications such as cardiac tamponade, phrenic nerve injury, and esophageal damage. Procedural parameters such as fluoroscopy time, energy delivery, and touch-up requirements favored PFA in multiple studies. Kaplan-Meier curves confirmed equivalent arrhythmia-free survival. Heterogeneity in protocols was noted but generally low across major outcomes. PFA offers comparable efficacy to HPSD while demonstrating a superior safety profile and procedural efficiency, supporting its role as a favorable ablation modality for AF.