Safety and efficacy of the pulsed field ablation for persistent atrial fibrillation: a meta-analysis

BACKGROUND: Pulsed field ablation (PFA) has emerged as an innovative non-thermal approach with significant promise for treating atrial fibrillation (AF). However, comparative data between PFA and thermal ablation (TA, including cryoballoon ablation [CBA] and radiofrequency ablation [RFA]) for persistent AF (PerAF) remain limited. METHODS: A systematic search was conducted in the Medline, PubMed, Embase, and Cochrane Library databases to include all relevant studies that compared PFA with TA. RESULTS: Six trials involving 1610 patients were included in the study. Pooled analyses revealed that PFA exerted significant advantages over TA, characterized by lower recurrence of atrial tachyarrhythmias (ATAs) (risk ratio [RR]: 0.83; 95% confidence interval [CI]: 0.70 to 0.97; P = 0.02), especially for AF recurrence (RR: 0.79; 95% CI: 0.65 to 0.95; P = 0.015). Furthermore, PFA significantly reduced procedural time (standard mean difference [SMD]: -1.25; 95% CI: -1.87 to - 0.64; P < 0.00001) and left atrial dwell (LAD) time (SMD: -14.21; 95% CI: -27.60 to - 0.82; P = 0.04). No significant differences were observed between the two groups regarding fluoroscopy time and complications. CONCLUSION: PFA is effective and safe for PerAF treatment, featuring shorter procedure time, LAD time and lower ATAs recurrence.