Comparative efficacy and safety of catheter ablation technologies for atrial fibrillation: a systematic review and network meta-analysis

Aims: There are several interventional approaches to atrial fibrillation (AF) ablation; however, it is not yet known which procedure is most effective. Our aim was to compare the efficacy and safety of different interventional approaches for the treatment of AF through network meta-analysis. Methods: We searched randomized controlled trial (RCT) and propensity-score matched (PSM) studies in PubMed, Embase, and Cochrane Library databases from the initial period to December 2024, and studies were selected which had cryoballoon ablation (CBA), conventional radiofrequency ablation (RFA), remote magnetic navigation ablation (RMN), and pulsed field ablation (PFA) as an arm in the study. Network meta-analysis (NMA) was performed using a frequentist approach with STATA (version 14.0) software. Results: We included 10 RCT studies and 4 PSM studies. For freedom from AF and other atrial tachyarrhythmias (AT) indicators, PFA may become the most effective ablation procedure (SUCRA = 88.4%, RR = 1.11, 95% CI: 1.03-1.21). For procedure duration, PFA may also be the ablation procedure with the best results (SUCRA = 91.2%, SMD = -1.43, 95% CI: -2.47 to -0.39). Conclusion: The choice of ablation technique needs to be weighed against the specific clinical needs and the patient's situation. PFA may be the best choice if success rate and procedure time are prioritized, while RMN is more appropriate if complication rates and fluoroscopy time are more important. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42025631158, identifier: CRD42025631158.