Abstract

Pulsed field ablation (PFA) is a novel modality for atrial fibrillation (AF). This analysis compared the safety and efficacy of PFA versus standard thermal ablation (STA) in subjects with paroxysmal AF. A comprehensive exploration of electronic databases was adopted to identify trials in English, of human studies, from inception to 10th October 2024, and compared PFA to STA for paroxysmal AF. Pooled analyses were performed to assess treatment success, AF recurrence, adverse events, procedural time, and other secondary outcomes. Three studies (n = 1733) were included in the analysis. PFA demonstrated a significantly higher success rate than STA (OR = 1.29, 95% CI = [1.05-1.58], p = 0.02). There was no potential difference in AF recurrence, procedural time, or secondary outcomes. Pericardial complications and vascular access consequences were more common in the PFA subjects. PFA is an alternative to STA for paroxysmal AF treatment, offering a higher initial success rate and comparable long-term efficacy. However, the increased risk of pericardial complications and vascular access complications should be carefully considered. Further research is required to support such outcomes and to better understand the long-term outcomes of PFA.

Key words: pulsed-field ablation, standard thermal ablation, atrial fibrillation, meta-analysis, systemic review