Pulsed-Field Ablation Versus Cryoballoon Ablation for Atrial Fibrillation: A Comparative Analysis

Pulsed-field ablation (PFA) is a nonthermal ablation method for pulmonary-vein isolation to treat atrial fibrillation. Limited data are available to compare PFA with cryoballoon ablation (CBA). 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. Twenty-one studies comprising 5,222 patients (2,297:PFA, 2,925:CBA) were included. Thirteen studies reported AF recurrence after the blanking period of 3 months, with a lower pooled risk seen in PFA (RR 0.81; 95% CI: 0.70, 0.92). Sixteen studies reported a periprocedural complications rate with a lower pooled risk in PFA than in CBA (RR: 0.67; 95% CI: 0.45, 1.00). Eighteen studies reported procedural time, which was lower with PFA (SMD -0.57; 95% CI: 0.88, -0.26). However, fluoroscopy time was higher with PFA (SMD: 0.26; 95% CI: 0.06, 0.46) (15 studies). Three studies reported an increase in high-sensitivity troponin, with higher levels after PFA (SMD: 2.05; 95% CI: 0.50, 3.61). A greater decrease in heart rate was observed in the PFA group postprocedure (SMD: -0.97; 95% CI: -1.73, -0.21) (4 studies). 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.